AG index page FAO homepage
Print this page | Close

ARCHIVE MERS-CoV situation update

17 October 2018, 17:00 hours; Rome

The next update will be issued on 21 November 2018

Disclaimer

Information provided herein is current as of the date of issue. Information added or changed since the last MERS-CoV situation update appears in red. Human cases are depicted in the geographic location of their report. For some cases, exposure may have occurred in one geographic location but reported in another. For cases with unknown onset date, reporting date was used instead. FAO compiles information drawn from multiple national (Ministries of Agriculture or Livestock, Ministries of Health; Centers for Disease Prevention and Control [CDC]) and international sources (World Health Organization [WHO], World Organisation for Animal Health [OIE]) as well as peer-reviewed scientific articles. FAO makes every effort to ensure, but does not guarantee, accuracy, completeness or authenticity of the information. The designation employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers.

 

 Overview

Situation: Middle East Respiratory Syndrome Coronavirus (MERS-CoV): zoonotic virus with pandemic potential.
Countries with known human cases1: Jordan, Saudi Arabia (KSA), Qatar, the United Arab Emirates (UAE), Oman, Kuwait, Yemen, United Kingdom*, France*, Germany*, Italy*, Tunisia*, Malaysia*, the Philippines*, the United States of America (USA)*, Egypt*, Lebanon*, the Netherlands*, Iran, Algeria*, Turkey*, Austria*, Greece*, Republic of Korea, China*, Thailand*, the Kingdom of Bahrain2.
Findings in humans: 2,263 cases confirmed; including 837 case fatalities (since September 2012)3.
Countries with published animal findings (serology and/or virology): Bangladesh, Burkina Faso, Chile, Egypt, Ethiopia, Iran, Israel, Jordan, Kenya, Kuwait, Mali, Morocco, Nigeria, Oman, Pakistan, Qatar, Saudi Arabia (KSA), Somalia, Spain (Canary Islands), Sudan, Tunisia, United Arab Emirates.

 

1 Countries in order of first reported occurrence
2 (*) denotes cases with travel to/through the Middle East/Arabian Peninsula
3 For detailed information on human cases, please refer to WHO at http://www.who.int/emergencies/mers-cov/en/

 

 Situation in animals

Map 1. MERS-CoV livestock field surveys by country*

Map of MERS-CoV livestock field surveys by country
Click to enlarge - *Note: Positive findings in Spain refer to samples taken in the Canary Islands. Livestock surveillance in Chile, not pictured, resulted negative.

 

 Situation in humans

  • Between 19 September and 17 October 2018, eleven (n=11) new human cases have been reported in Saudi Arabia, including five (n=5) fatalities.

Map 2. For a global distribution of human MERS-CoV cases please see our map [here]

 

Table 1. MERS-CoV cases in humans by country and dates of first and most recent observations

 

 

Country

Cumulative number of confirmed MERS-CoV human cases

First observation

Last Observation

Middle East Saudi Arabia 1,886 13/06/2012 16/10/2018
United Arab Emirates 88 19/03/2013 04/05/2018
Jordan 26 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 11 26/10/2013 23/02/2018
Iran (Islamic Republic of) 6 11/05/2014 18/03/2015
Kuwait 4 30/10/2013 08/09/2015
Lebanon 2 22/04/2014 08/06/2017
Yemen 1 17/03/2014 17/03/2014
Bahrain (the Kingdom of) 1 04/04/2016 04/04/2016
Europe United Kingdom 5 03/09/2012 16/08/2018
Germany 2 05/10/2012 07/03/2015
Netherlands 2 01/05/2014 05/05/2014
France 2 23/04/2013 27/04/2013
Austria 2 22/09/2014 08/09/2016
Turkey 1 25/09/2014 25/09/2014
Italy 1 25/05/2013 25/05/2013
Greece 1 08/04/2014 08/04/2014
Asia Republic of Korea 186 11/05/2015 28/08/2018
Philippines 3 15/04/2014 30/06/2015
Thailand 3 10/06/2015 25/07/2016
China 1 21/05/2015 21/05/2015
Malaysia 2 08/04/2014 24/12/2017
Americas United States of America 2 14/04/2014 01/05/2014
Africa Tunisia 3 01/05/2013 17/06/2013
Algeria 2 23/05/2014 23/05/2014
Egypt 1 22/04/2014 22/04/2014

Figure 1. Human epidemiological timeline (with cases reporting animal exposure in blue), by month of disease onset (since September 2012)
Human epidemiological timeline (with cases reporting animal exposure in blue), by month of disease   onset (since September 2012)

Click to enlarge

Figure 2. Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Click to enlarge - Note: Please note that while infection control improves in healthcare settings and history of animal contact is recorded more consistently in case investigations, the overall number of cases has decreased (see figure 1). The apparent increase in proportion of primary cases with animal exposure therefore should be interpreted in the overall context of a reduced human case count. Data not displayed prior to July 2015 as a result of inconsistent collection of human epidemiological data before this date.

 

 Recent publications

  • FAO-OIE-WHO MERS Technical Working Group. MERS: Progress on the global response, remaining challenges and the way forward. Antiviral Res. 2018 Sep 17;159:35-44. doi: 10.1016/j.antiviral.2018.09.002.[reference] This article summarizes progress in research on Middle East Respiratory Syndrome (MERS) since a FAO-OIE-WHO Global Technical Meeting held at WHO Headquarters in Geneva on 25-27 September 2017. Progress has been made on several key actions in animal populations, at the animal/human interface and in human populations. This report also summarizes the latest scientific studies on MERS since 2017, including data from more than 50 research studies examining the presence of MERS-CoV infection in dromedary camels.
  • Zohaib A, Saqib M, Athar MA, Chen J, Sial AU, Khan S, Taj Z, Sadia H, Tahir U, Tayyab MH, Qureshi MA, Mansoor MK, Naeem MA, Hu BJ, Khan BA, Ujjan ID, Li B, Zhang W, Luo Y, Zhu Y, Waruhiu C, Khan I, Yang XL, Sajid MS, Corman VM, Yan B, Shi ZL. Countrywide Survey for MERS-Coronavirus Antibodies in Dromedaries and Humans in Pakistan. Virol Sin. 2018 Oct 11. [reference] Through surveillance in Pakistan, nasal (n=776) and serum (n=1050) samples were collected from camels between November 2015 and February 2018. Samples were collected from animal markets, free-roaming herds and abattoirs. An in-house ELISA was developed to detect IgG against MERS-CoV. A total of 794 camels were found seropositive for MERS-CoV. Prevalence increased with the age and the highest seroprevalence was recorded in camels aged > 10 years (81.37%). Of the camel nasal swabs, 22 were found to be positive by RT-qPCR with high Ct values. Moreover, 2,409 human serum samples were also collected from four provinces of Pakistan during 2016-2017, though no neutralizing antibodies were detected in humans with and without contact to camels.
  • Kamau E, Ongus J, Gitau G, Galgalo T, Lowther SA, Bitek A, Munyua P. Knowledge and practices regarding Middle East Respiratory Syndrome Coronavirus among camel handlers in a Slaughterhouse, Kenya, 2015. Zoonoses Public Health. 2018 Sep 20. [reference] In this study, knowledge and practices regarding MERS among herders, traders and slaughterhouse workers were assessed at Athi-River Slaughterhouse, Kenya. Questionnaires were administered, and a check list was used to collect information on hygiene practices among slaughterhouse workers. Of 22 persons, all washed hands after handling camels, 82% wore gumboots, and 65% wore overalls/dustcoats. None of the workers wore gloves or facemasks during slaughter processes. Fourteen percent reported drinking raw camel milk; 90% were aware of zoonotic diseases with most reporting common ways of transmission as: eating improperly cooked meat (90%), drinking raw milk (68%) and slaughter processes (50%). Sixteen (73%) were unaware of MERS-CoV. These findings highlight need to disseminate information about MERS-CoV and enhance hygiene and biosafety practices among camel slaughterhouse workers to reduce opportunities for potential virus transmission.

 

 FAO and MERS-CoV

  • The meeting report from the FAO-OIE-WHO tripartite meeting held in Geneva, 25-27 September 2017 has been published in Antiviral Research [reference].
  • A poster entitled ‘MERS-CoV in Animals: a Scoping Review’ has been accepted for the 5th International One Health Congress in Saskatoon, Canada from 22-25 June 2018.
  • A poster entitled ‘Harmonization and flexibility in a multi-country project - FAO MERS-CoV surveillance in camels’ has been accepted for the Prince Mahidol Award Conference (PMAC) held in Bangkok, Thailand from 29 January to 3 February 2018.
  • A FAO-OIE-WHO tripartite meeting was held in Geneva, 25-27 September 2017 [reference]. Representatives from Ministries of Health and Ministries of Agriculture in affected and at risk countries, MERS-CoV subject-matter experts and researchers, funders, industrial partners and representatives from FAO, OIE and WHO attended. The specific objectives of this meeting were to (i) summarize and communicate research progress made, with a focus on new research and knowledge gained; (ii) improve coordination and communication between animal health and public health sectors in outbreak preparedness and response, active surveillance and technical issues of disease control and prevention, and (iii) to review and update previous recommendations based on latest scientific evidence. [#tackleMERS]
  • In close collaboration with OIE and WHO, monitoring the situation / inter-agency teleconferences;
  • Analysing available data, including results from surveillance in camels and advanced characterization of the virus;
  • Providing technical assistance and guidance to countries to improve understanding of the disease situation and help filling existing gaps in epidemiological knowledge;
  • Supporting national laboratories to develop capacity in serology and PCR diagnostic for MERS-CoV, quality assurance and quality control and biosafety, and establish national sample banks;
  • Keeping a dialogue between the scientific community and the field to ensure needs and gaps are addressed;
  • Assist in developing communication strategies to ensure appropriate information reaches the public on MERS-CoV and avoid possible negative impacts of the crisis on the livestock industry.

Country-level actions

Egypt

  • Joint implementation of the repeat cross-sectional surveillance study in villages, markets, slaughter houses and quarantine stations by the General Organization for Veterinary Services (GOVS) and the Animal Health Research Institute (AHRI) continues:
    • A total of 936 camel sera and 936 nasal swabs were collected from villages, markets, slaughterhouses and quarantine stations;
    • Approximately 90% of samples collected during the first phase of the study tested positive in serology using the Anti-MERS ELISA assay to detect camel humeral immune response (IgG) to MERS-CoV S1 antigen.
  • Sample testing by Animal Health Research Institute (AHRI) is ongoing, and the Letter of Agreement has been amended to support the sequencing of isolated samples.
  • Two lab personnel from the Serology and Genome Unit of the Animal Health Research Institute (AHRI) participated in a 6 day training course from 23 to 28 September 2018 in Rotterdam, Netherlands. The training on the molecular and serological detection of MERS-CoV was organized by the Viroscience Department at the Erasmus Medical Center to provide technical support to AHRI for sequencing of isolates from camel samples.

Ethiopia

  • The FAO-NAHDIC joint longitudinal and repeated cross-sectional surveillance sample collection has been completed in five sampling locations of the Amibara District and three sampling locations of the Yabello District.
    • A total of 1 643 camel nasal swabs and 839 sera samples have been collected in duplicate since February 2018.
  • 1 523 camel nasal swab samples were sent to the University of Hong Kong for molecular testing and sequencing of positive samples, with results expected this month.
    • Preparations are underway for shipment of a further 250 camel nasal swab and 130 sera samples.
  • The joint longitudinal study with the College of Veterinary Medicine and Agriculture of the Addis Ababa University is underway in Halaydege and Bedhamo locations of the Afar Regional State.

Kenya

  • Implementation of the longitudinal studies is underway:
    • Serological testing of collected samples is ongoing at the Central Veterinary Laboratory (CVL) with official results yet to be released by the Directorate of Veterinary Services (DVS);
  • 1000 camel nasal swabs have been submitted to the Institute of Virology, Charité – Universitätsmedizin Berlin, Germany for molecular analysis (PCR and sequencing) with results expected later this month;
  • Eighteen rounds of sampling have been finalized in the enrolled study herds (a pastoral herd and a ranch in Isiolo and Nakuru counties, respectively); 1 472 nasal swabs and sera were collected.
  • Approximately 495 tracheal swabs have been collected from camels at Isiolo slaughterhouse;
  • The manuscript titled “Detection of distinct MERS-Coronavirus strains in dromedary camels from Kenya, 2017” was accepted for publication by the journal Emerging Microbes and Infections Journal (EMI).

Jordan

  • Repeated cross-sectional surveillance is being completed by the staff of Ministry of Agriculture through collecting samples from 2 designated locations with previous history of PCR-positive MERS-CoV findings in camels:
    • A total of 260 nasal swabs and serum samples have been collected from the two locations;
    • A new letter of agreement will be signed with Jordan University of Science and Technology (JUST) and Ministry of Agriculture to continue surveillance until the end of December 2018.
  • A camel value chain study was accepted and published in Global Veterinaria under title "Analysis, Description and Mapping of Camel Value Chain in Jordan".
    (see Update of 19 September 2018)
  • Field-testing of the questionnaires for the Anthropological study will be conducted through a Letter of Agreement with JUST University; this study will aim at investigating and describing contact patterns at the human-camel interface.

 

Press Releases

 

 Important links