The season of the MERS...is mainly whenever the infection control fails

I still only see a "seasonality" to MERS and human MERS-CoV detections that is made up of the times when hospital outbreaks spread cases due to missed opportunity to control and prevent infection wihtin their walls. In other words - no real season at all. 

MERS-CoV is an opportunistic virus - which includes making the most of the frequent opportunities we humans provide for it to spread.

Data from public sources up until December 3rd 2015.
Click on image to enlarge.

Any true seasonality is in that small percentage of cases that are the result of a primary, sporadic infection from an infected and infectious camel. Those cases may be related to times of camel calf weaning when young camels acquire their first infection, or it might just be whenever a particular herd has MERS-CoV raging though it.

MERS-CoV: Saudi Arabia still tops the chart..by a long way

A quick reminder that MERS and the MERS-CoV remain a thing of the Kingdom of Saudi Arabia from where 80% of detections have been reported.

South Korea's hospital outbreak comprises 11% of all reported detections.

Want me to review your manuscript for free? Then be polite...

"It has been 3 days since an E-mail inviting you to review XXX-YYYYY-ZZZZ, entitled "Rbah blah blah". Could you please inform us of your decision by clicking on the link at the bottom of the page with your decision as soon as possible?"

"Actually mate, I have already replied to this email address, which I assume is yours. 

I did that in the 28th of November, a Saturday, and approximately 10 minutes after I received your review request - that was 10:47pm at night, my time. 

But given your tone, I should probably have just ignored it for the spam it must have been. 

A professional journal would make a second approach for my review with some degree of professionalism. I am acutely aware of how hard it is to get peers to reply, let alone agree, to manuscript review requests as I am a Section Editor, an Associate Editor and on 2 editorial boards myself. However, I have never chased up a potential reviewer using such a short tone. 

Please remove me from your list of potential reviewers. I would no more review for you or this journal again, than poke myself in the eye with a sharp stick."

Updating the animal "to-do" list...

I have a couple of talks coming up, so I'm making graphics again. And I like to share those. 

This one is an update on some of the creatures that could also be considered suspects in the hunt for sources of MERS-CoV infection of humans.

Of course, camels are the ones we know to be a true risk for infection and there was that 1 bat that was positive for a very small diagnostic PCR product. Cattle contact was also recently listed, with little detail, as a significant risk factor among those acquiring MERS-CoV infection and we also know that cells from camels, horses, alpacas, cattle and goats can be infected and host genome or virus replication of MERS-CoV in the lab, or have the MERS-CoV cellular receptor, DPP4, on their surface.[1,2]

I heard that there will be more bat testing in the future, but we haven't read of any MERS-CoV targeted bat studies since 2013.

So here is the long laundry list of animal testing that needs more work - many of which have been tested in small numbers over limited time periods already - in a graphical form.

Click on image to enlarge.
You can also access this from Figshare.[3]

References...

1. http://www.ncbi.nlm.nih.gov/pubmed/25656066
2. http://wwwnc.cdc.gov/eid/article/22/1/15-1340_article
3. http://figshare.com/articles/Creatures_of_interest_to_how_humans_acquire_a_MERS_CoV_infection/1609604

Liberia reports another case of Ebola virus infection...

Reset the contacts clocks. Liberia has had a second setback in the fight to rid West Africa of human Ebola virus (EBOV) infections. 

While we were academically aware this could happen again, I'd venture to say we probably thought the next case of Ebola virus disease (EVD) would return to Sierra Leon or Guinea. Liberia which was declared free of known transmission back in 03-SEPT-2015...78-days or 2-months and 17-days ago, and was without a case for 42 days before that.

This was where I learned about the new case from...

Looks like new case of #Ebola here in #Liberia. I'm confident that the Govt will again contain it effectively. Hope the poor boy recovers.

— Sinead Walsh (@SWalshIRL) November 20, 2015

It has now been confirmed that a 15-year old male, the beginning of Liberia's "fourth wave" of EVD, acquired EBOV from....somewhere...somehow.[9] 

15M became ill from 13-Nov and was confirmed as EBOV infected 19-Nov.[7,8,9] He died 24-NOV.[12]

UPDATE #1: tally now stands at 3 cases - the 2 new cases among family members of 15M include his 8-year old brother and his father.[8,9] It has been said that 15M had no known contact with a survivor or relevant travel history.[9] 15M was previously described as 10M, but age amended in [9]) 
UPDATE #2: 153 contacts being monitored.[10]
UPDATE #3: WHO lists boy as 10-year old in 23NOV update. Aiyahh!  
UPDATE #4: Announcement of 10M death.[12]
UPDATE #5: Guess what? WHO says 15M.[13] Father, 40M.[13] 149 contacts including 10 healthcare workers.
UPDATE #6: 40M and 8M were discharged from hospital but some contacts still have a week of observation to complete.[14]

Information on how the initial infection for this cluster was acquired.

Time will may tell us more.

Reference...

1. http://www.focus-fen.net/news/2015/11/20/390066/one-new-confirmed-case-in-previously-ebola-free-liberia-who.html
2. http://www.reuters.com/article/2015/11/20/health-ebola-liberia-idUSL8N13F1HC20151120#LtSB8YECI4XoKEl3.97
3. http://www.theguardian.com/world/2015/nov/20/ebola-case-in-liberia-confirmed-by-who
4. http://www.itv.com/news/update/2015-11-20/ebola-case-confirmed-in-liberia/
5. http://www.nytimes.com/aponline/2015/11/20/world/africa/ap-af-ebola-west-africa.html?_r=0
6. http://africanspotlight.com/2015/11/20/new-ebola-case-discovered-in-liberia-un/
7. http://www.npr.org/sections/goatsandsoda/2015/11/20/456787852/ebola-returns-to-liberia-but-its-not-clear-how-the-10-year-old-got-it
8. http://www.bbc.com/news/world-africa-34882191
9. http://www.nytimes.com/2015/11/21/world/africa/ebola-case-in-10-year-old-confirmed-in-liberia.html?_r=0
10. http://www.reuters.com/article/2015/11/22/health-ebola-liberia-idUSL8N13H0CM20151122#Ug24kslkc6Qo48g0.97 
11. http://who.int/csr/disease/ebola/flare-up-liberia/en/
12. http://www.reuters.com/article/2015/11/24/health-ebola-liberia-idUSL8N13J1V820151124#bCYKBOZy3DTtz7US.97
13. http://apps.who.int/ebola/current-situation/ebola-situation-report-25-november-2015
14. http://www.trust.org/item/20151203193032-4wnba

National Health and Medical Research Council: project grant funding successes for supply in 2016...

Just a short one.

Putting up a graph I posted on Twitter 09-NOV-2015 in case anyone wanted the chart.

This is a better quality image.

Click on image to enlarge

You can move money around to young or old or male or female, and dress it up as people support or project support - but until the pot of cash grows, or researchers stop applying, success rates will remain dismal or get worse.

Perhaps the Medical Research Future Fund will do this. At some point. If the will remains.....sigh

Interlude....

...the camel data review will return soon.

Congratulations to Sierra Leone for defeating its Ebola virus disease epidemic!

Edited by Katherine Arden, PhD.

"On Behalf of the Sierra Leone National Ebola Response Centre (NERC) and the World Health Organisation (WHO)

Note to Correspondents

Subject: Ebola transmission in Sierra Leone over. 

Nation enters 90-day enhanced surveillance period
On 7 November 2015, if no new case of Ebola virus disease is recorded, Sierra Leone will have met the criteria set by the World Health Organization (WHO) for declaring the end of Ebola transmission. If Sierra Leone meets that milestone, on that day, the WHO will declare the end of Ebola transmission in Sierra Leone, at an event organised by the Government of Sierra Leone through the National Ebola Response Centre (NERC)."

This is the message that greets you on the NERC website today. Ebola virus transmission has finally been kicked out of Sierra Leone after a 42 period with no cases confirmed. Getting to zero is now, Got to zero!

CONGRATULATIONS!!! 

It has been a hard fought battle with many, many losses. Battling the Ebola virus has also provided many teaching moments for the nation...as it has been for Liberia and still is for Guinea...and the world.

Within the next 90 day enhanced surveillance period and in the months and months to come, we may see a case or cases pop up and clusters may result. But Sierra Leone knows what Ebola virus disease is and how to deal with it. It won't be caught out the same way again. 

Many more teaching moments undoubtedly remain. But each will surely be faced with the same strength and passion that drove the nation to defeat an epidemic the likes of which the world had never before seen. 

The people of Sierra Leone made many new friends during this tragedy and hopefully they will always be but a call or a text or an email away. Far too many of those incredibly brave local and international health workers, burial teams, laboratory specialists and ambulance drivers paid for their efforts with their lives. So to them, to those who survived, to all the contact tracers, the social anthropologists, the psychosocial experts, the survivor clinics, the organizers, the facilitators, the doers and the thinkers from within and outside Sierra Leone, we give our heartfelt thanks for your work and your many sacrifices. You together with the people of Sierra Leone all contained and defeated Ebola virus disease and you did it in the face of often overwhelming odds. 

Enjoy the parties. Remember the lessons. Be vigilant.

References...

1. http://nerc.sl/

Updating the very model of a modern mammal-camel....

The new findings from the case-control study out of the Kingdom of Saudi Arabia (and US CDC) deserve an update of my old model of how one might become infected with MERS-CoV after exposure to an infected camel.[1,2]

Some of the possible ways in which MERS-CoV may be spread from an infected
camel to a human in direct or close contact with the camel or with surfaces
onto which MERS-CoV-laden camel excretions or secretions have been deposited.

The major change is the removal of the ingestion options. As readers of this blog will know, I've never been a "believer" in that route of infection, and the new study would seem to support that gut feeling with some facts.

As ever, the distinction between direct contact and being close enough to be exposed to droplets that are inhaled, has not been possible and wasn't attempted. The word "droplet" does not appear anywhere in the paper. In fact, animal contact and droplet-producing processes are all rolled together in the new study under the direct contact banner - so I have retained droplets among the possible risks shown in the figure.

References...

1. http://virologydownunder.blogspot.com.au/2015/11/it-was-camel-in-library-with-mers-cov.html
2. http://virologydownunder.blogspot.com.au/2014/05/camels-at-centre-aerosol-all-around.html

It was the camel, in the library, with the MERS-CoV...

In a paper out overnight, which is assigned to the January 1st 2016 edition of Emerging Infectious Diseases (why do you do this to us EID?!), Alraddadi and colleagues (overwhelmingly from the Kingdom of Saudi Arabia with help from the Centers for Disease Control and Prevention in the United States) have published Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014. 

This is a long awaited case control study. Long awaited.

From [2]

It tells us that direct contact with dromedary camels (including the act of milking them) in Saudi Arabia, in the 2 weeks prior to symptoms ascribed to a confirmed MERS-CoV infection, is a significant risk factor for developing Middle East respiratory syndrome (MERS) disease. Cattle contact also fell out as a significant risk. 

However, cases were no more likely than controls to report exposure to bats, goats, horses, sheep or consumption of fruits, vegetables, or animal products, including uncooked meat, unpasteurized animal milk, or dromedary urine. 

The study also reminds us that the host factors of diabetes, heart diseases and smoking are associated with MERS (the disease, not how likely you are to get infected). If you do not have these then you may be more likely to have mild or asymptomatic outcomes if you were to be exposed and infected by MERS-CoV.

These are astounding findings that will take many by surprise and revolutionize out understanding of MERS (the disease) and MERS-CoV (the virus) throughout the Arabian Peninsula. 

Said no-one. Ever.

Ridiculous sarcasm aside though, much kudos to the Saudi research community! This case-control study, a long-awaited piece of work, was a camel that had to be broken by them for them, and now it has been. A win for science and for the region's science.

I hope the study helps to confirm the sizable pool of research that has come before.

But let's not lose sight of the camel in the room; most human cases of MERS come from other human infections closely associated with healthcare settings.

Defeating MERS and MERS-CoV requires battles on many fronts. As usual for any emerging viral disease. 

But then, it's a OneHealth kinda world.

References...

1. http://wwwnc.cdc.gov/eid/article/22/1/15-1340_article
2. http://virologydownunder.blogspot.com.au/2014/05/camels-at-centre-aerosol-all-around.html