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ARCHIVE MERS-CoV situation update

25 October 2017, 17:00 hours; Rome

The next update will be issued on 22 November 2017

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: 2,100 cases confirmed; including 782 case fatalities (since September 2012)3.
Countries with published animal findings (serology and/or virology): Burkina Faso, Spain (Canary Islands), Egypt, Ethiopia, Iran, Jordan, Kenya, Kuwait, Mali, Morocco, Nigeria, Oman, Pakistan, Qatar, Saudi Arabia (KSA), Somalia, 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 28 September and 24 October 2017, eight (n=9) new human cases have been reported, including three fatalities (n=3), all in Saudi Arabia.

Map 2. Global distribution of human cases of MERS-CoVMap of global distribution of human cases of MERS-CoV

Click to enlarge

 

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 1,730 13/06/2012 24/10/2017
United Arab Emirates 86 19/03/2013 11/08/2017
Jordan 26 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 9 26/10/2013 09/08/2017
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 1 08/04/2014 08/04/2014
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.

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

 

 Recent publications

  • Lau SKP, Wong ACP, Lau TCK, Woo PCY. Molecular Evolution of MERS Coronavirus: Dromedaries as a Recent Intermediate Host or Long-Time Animal Reservoir? Int J Mol Sci. 2017 Oct 16;18(10). pii: E2138. doi: 10.3390/ijms18102138. [reference] This research discusses the role of camels in the evolution of MERS-CoV. Phylogenetic analysis was undertaken on 219 camel and human MERS-CoV genome sequences available in GenBank. It showed that 5 and 214 strains belong to clade A and B, respectively, with clade A further divided into lineage A1 (3 human strains) and lineage A2 (2 camel strains), and clade B divided into lineages B1 to B6 (each containing both human and camel strains). Recombination analysis showed potential recombination events in five strains from dromedaries in Saudi Arabia.
  • Kasem S, Qasim I, Al-Hufofi A, Hashim O, Alkarar A, Abu-Obeida A, Gaafer A, Elfadil A, Zaki A, Al-Romaihi A, Babekr N, El-Harby N, Hussien R, Al-Sahaf A, Al-Doweriej A, Bayoumi F, Poon LLM, Chu DKW, Peiris M. Cross-sectional study of MERS-CoV-specific RNA and antibodies in animals that have had contact with MERS patients in Saudi Arabia. J Infect Public Health. 2017 Oct 6. pii: S1876-0341(17)30257-5. doi: 10.1016/j.jiph.2017.09.022. [reference] The study was designed to investigate animal herds associated with Middle East respiratory syndrome (MERS)-infected patients in Saudi Arabia, during the last three years (2014-2016). Nasal swabs and serum samples from 584 dromedary camels, 39 sheep, 51 goats, and 2 cattle were collected and examined by real-time reverse-transcription PCR (RT-PCR). Complete genome sequencing and phylogenetic analysis of ten MERS-CoV camel isolates was performed. The findings of this study indicate that camels are a significant reservoir for the maintenance of MERS-CoVs and an important source of human infection with MERS.
  • Stephen A. Goldstein, and Susan R. Weiss. Origins and pathogenesis of Middle East respiratory syndrome-associated coronavirus: recent advances. Version 1. F1000Res. 2017; 6: 1628. Published online 2017 Sep 1. doi:  10.12688/f1000research.11827.1. [reference] This review is focusing on three particular areas: the origins and evolution of MERS-CoV, the challenges and achievements in the development of MERS-CoV animal models, and our understanding of how novel proteins unique to MERS-CoV counter the host immune response.
  • Houser KV, Broadbent AJ, Gretebeck L, Vogel L, Lamirande EW, Sutton T, Bock KW, Minai M, Orandle M, Moore IN, Subbarao K. Enhanced inflammation in New Zealand white rabbits when MERS-CoV reinfection occurs in the absence of neutralizing antibody. PLoS Pathog. 2017 Aug 17;13(8):e1006565. doi: 10.1371/journal.ppat.1006565. eCollection 2017 Aug.[reference] This research was designed to discover more about non-lethal infections and to learn whether a single infection with MERS-CoV would protect against reinfection using a rabbit model. Data generated from the rabbit model suggests that people exposed to MERS-CoV who fail to develop a neutralizing antibody response, or persons whose neutralizing antibody titers have waned, may be at risk for severe lung disease on re-exposure to MERS-CoV.

 

 FAO and MERS-CoV

  • 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

Kenya

  • Longitudinal surveillance (cohort study) is ongoing at Soysambu Ranch in Nakuru County. Nine rounds of sampling have been conducted. Testing is ongoing at the country’s Central Veterinary Laboratories (CVL). 
  • Longitudinal surveillance (repeat cross sectional studies) ongoing in Isiolo County; four rounds of sampling have been conducted so far and testing is ongoing at CVL.
  • Kenya shipped 2,240 nasal swabs to the Institute of Virology, Charité – Universitätsmedizin Berlin, Germany for molecular analysis. These include 59 nasals swabs from other species (sheep, donkey, cattle and cattle).

Ethiopia

  • 165 camel nasal swab samples from the FAO-PREDICT 2 joint surveillance site (Awash area) will be tested for five viral families using the PREDICT protocol;
  • A stakeholders consultation to fine-tune the upcoming repeated cross-sectional surveillance study is planned to be held in early November 2017. Discussions will include how to align joint surveillances studies on MERS-CoV in camels, bats and humans as well as studies to identify possible anthropological, behavioural and socio-economic risk factors for MERS-CoV human exposure in Ethiopia.

Egypt

  • Both longitudinal and cross sectional surveillance rounds are delayed and hopefully recommence soon.
  • For the cross sectional surveillance, samples will be collected form 46 villages and stored at the Animal Health Research Institute (AHRI) lab to be analysed upon receiving kits and reagents.
  • The first round of longitudinal surveillance (repeated cross sectional), will last for 2 weeks. The National Research Centre (NRC) team in collaboration with the General Organization for Veterinary Services (GOVS) will collect samples from different nodes along the camel value chain in Egypt.
  • ECTAD Egypt reached out to the camel officer in the “Desert Research Centre” to discuss possibilities for collaboration in the planned value-chain study update.
  • An anthropologist was contacted to conduct a behavioural study is planned for March 2018.

Press Releases

  • 25-27 September 2017: FAO-OIE-WHO Global Technical Meeting on MERS-CoV [#tackleMERS]
  • 13-14 December 2016: FAO inter-regional training workshop: “Analysis of camel value chains and human behaviours in view of MERS-CoV surveillance”.
  • 7 November 2016: FAO_ECTAD Egypt trains Laboratory staff from Animal Health Research Institute (AHRI) and the National Research Center (NRC) on lab tests for (MERS-CoV).
  • 30 March 2016: Launching of the “Reference Centre and Network on camel diseases” for the Gulf and neighbouring countries. (in Arabic)
  • 28 January 2016: FAO pushes for a road map to control and contain zoonotic diseases.
  • 21 to 22 January 2016: Technical Meeting: Understanding MERS-CoV at the animal-human interface at FAO-HQ in Rome, Italy.
  • 20 October 2015: U.S. backs FAO efforts to combat global animal disease threats with $87 million.
  • 27 April 2015: Stepping up efforts for a better understanding of MERS at the human-animal interface.

 Important links