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ARCHIVE MERS-CoV situation update

17 January 2018, 17:00 hours; Rome

The next update will be issued on 21 February 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 Organisatwion 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: 2,146 cases confirmed; including 807 case fatalities (since September 2012)3.
Countries with published animal findings (serology and/or virology): Burkina Faso, Egypt, Ethiopia, Iran, 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.

 

 Situation in humans

  • Between 20 December 2017 and 17 January 2018, Twenty-two (n=22) new human cases have been reported: twenty (n=20) in Saudi Arabia, including fourteen fatalities (n=14), one (n=1) in Malaysia (exposed in the Arabian Peninsula [link]) and one (n=1) in the United Arab Emirates.

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 1,773 13/06/2012 13/01/2018
United Arab Emirates 87 19/03/2013 22/12/2017
Jordan 26 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 10 26/10/2013 01/11/2017
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 4 03/09/2012 05/02/2013
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 185 11/05/2015 02/07/2015
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
Click to enlarge

Figure 2. Breakdown of human MERS-CoV cases by potential source of exposure (in percent). 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.

Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Click to enlarge

 

 Recent publications

  • Gytis Dudas, Luiz Max Carvalho, Andrew Rambaut and Trevor Bedford. MERS-CoV spillover at the camel-human interface. eLife 2018;7:e31257 DOI: 10.7554/eLife.31257 [reference]. A new analysis of genetic history confirms that Middle East respiratory syndrome virus, does not spread easily between humans i.e MERS-CoV is poorly suited for human transmission. Authors used existing MERS-CoV sequence data to explore its phylodynamics in humans (174) and camels (100). They employed structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analyzing the distribution of human outbreak cluster sizes and zoonotic introduction times they showed that human outbreaks in the Arabian Peninsula are driven by seasonally varying zoonotic transfer of viruses from camels.
  • Ana Moreno, Davide Lelli, Luca de Sabato, Guendalina Zaccaria, Arianna Boni, Enrica Sozzi, Alice Prosperi, Antonio Lavazza, Eleonora Cella, Maria Rita Castrucci, Massimo Cicozzi, and Gabriele Vaccari. Detection and full genome characterization of two beta CoV viruses related to Middle East respiratory syndrome from bats in Italy. Virol J. 2017; 14: 239.Published online 2017 Dec 19. doi:  10.1186/s12985-017-0907-1. [reference] Two beta CoVs closely related to MERS were obtained from two bats belonging to two commonly recorded species in Italy (P. kuhlii and H. savii). Both samples addressed by this study resulted positive to the pan-coronavirus RT-PCR (IT-batCoVs). The full IT bat CoV sequences showed the same genome organization as MERS-CoV either for the 10 open reading frames (ORFs) or the common non-translated sequences identified in CoV genomes. The overall nucleotide identity to MERS CoV is close to 78%, and in the phylogenetic tree they are represented in the same MERS-like clade 2c.
  • Francesca Rizzo, Kathryn M. Edenborough, Roberto Toffoli, Paola Culasso, Simona Zoppi, Alessandro Dondo, Serena Robetto, Sergio Rosati, Angelika Lander, Andreas Kurth, Riccardo Orusa, Luigi Bertolotti, and Maria Lucia Mandola. Coronavirus and paramyxovirus in bats from Northwest Italy. BMC Vet Res. 2017; 13: 396. Published online 2017 Dec 22. [reference] This research aimed at performing surveillance studies within a specific geographic area which can provide awareness of viral burden where bats roost in close proximity to spillover hosts, and form the basis for the appropriate control measures against potential threats for public health and optimal management of bats and their habitats. This study identified alpha and beta-CoVs in new bat species and in previously unsurveyed Italian regions. CoV RNA was found in 36 bats belonging to eight species and phylogenetic characterization has been obtained for 15 alpha- CoVs and 5 beta-CoVs; moreover one P. pipistrellus resulted co-infected with both CoV and paramyxovirus. 

     

 

 FAO and MERS-CoV

  • 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) to be 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

Ethiopia

  • Preparations to implement the longitudinal and repeated cross-sectional surveillance studies in the Amibara area, Afar Regional State, and Yabelo area, Oromia Regional State, are underway:
    1. Letters of Agreement with the NAHDIC, AAU and University of Hong Kong (HKU) are being set up;
    2. Two masters students from the NAHDIC will be involved in the applied research;
    3. Field sample collection will be starting in early February.
  • Field data collection from the Afar, Humera and Bati areas for the value chain and production systems characterization has been finalized. Currently, field teams are in the Arero area, Oromio Regional State. Due to security reasons, field data collection cannot be conducted in Somali Regional State.
  • The work plan has been reviewed based on recommendations from the Geneva meeting and agreed objectives with the USAID, i.e. 1) Longitudinal surveillance; 2) Anthropological studies; and 3) Isolation and identification of the viral strains.
  • Analysis of the results from phase 1 of the cross-sectional surveillance study in Ethiopia has been accepted for a poster presentation during PMAC 2018, entitled ‘Cross-sectional surveillance for Middle East Respiratory Syndrome Coronavirus in camels and associated livestock in Ethiopia’.  

Jordan

  • Starting in November 2017, longitudinal (repeated cross-sectional) surveillance was conducted in Al Azraq and Ar Ramtha regions as 3 successive samplings from each region with one week intervals between sampling. This work was carried out through a letter of Agreement with the Jordan University of Science and Technology (JUST) and in collaboration with the Ministry of Agriculture. While all samples tested PCR negative, sero-prevalence was ranging from 46.6% in week 1 to 20% in week 3.
  • A camel value chain study covering the entire Kingdom of Jordan was conducted including all nodes and players within the chain (quarantine stations, slaughterhouses, camel owners, butchers, racing camels and lay people, etc.).
  • The work plan was amended according to Geneva meeting recommendations and agreed objectives with USAID.

Press Releases

 Important links