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ARCHIVE MERS-CoV situation update

19 September 2018, 17:00 hours; Rome

The next update will be issued on 17 October 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: 2,252 cases confirmed; including 832 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. The map has been updated following a literature search.

 

 Situation in humans

  • Between 24 August and 19 September 2018, sixteen (n=16) new human cases have been reported, fifteen (n=15) in Saudi Arabia, including three (n=3) fatalities, and one (n=1) in the Republic of Korea.
    Note: The MOH webpage for Saudi Arabia is currently under maintenance; the reported data could be subject to change.

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 1,875 13/06/2012 16/09/2018
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

  • Al-Tawfiq JA, Memish ZA. Lack of seasonal variation of Middle East respiratory syndrome coronavirus (MERS-CoV). Travel Med Infect Dis. 2018 Sep 12. pii:S1477-8939(18)30238-2. doi: 10.1016/j.tmaid.2018.09.002. [reference] This paper examines the transmission of MERS-CoV and looks at possible seasonal variation in the transmission between humans and animals, as can be seen in several other viruses. 
  • Chu DK, Oladipo JO, Perera RA, Kuranga SA, Chan SM, Poon LL, Peiris M. Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels in Nigeria, 2015. Euro Surveill. 2015;20(49). doi: 10.2807/1560-7917.ES.2015.20.49.30086. [reference] In this study, evidence of current and past Middle East respiratory syndrome coronavirus (MERS-CoV) infection in dromedary camels slaughtered at an abattoir in Kano, Nigeria in January 2015, was sought by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and serology. MERS-CoV RNA was detected in 14 (11%) of 132 nasal swabs and antibody in 126 (96%) of 131 serum samples. Phylogenetic analyses demonstrate that the viruses in Nigeria are genetically distinct from those reported in the Arabian peninsula.
  • Abutarbush, Hijazeen, Doodeen, Hawawsheh, Ramadneh, Al Hanatleh. Analysis, Description and Mapping of Camel Value Chain in Jordan. Global Veterinaria 20 (3): 144-152, 2018. [reference] The aim of this study is to improve understanding of the camel sector and value chain in Jordan through review of national governmental records and data system, scientific literature and internet data. Also senior management of the Ministry of Agriculture and value chain actors were interviewed. The five levels in the main camel value chain in Jordan included the input supply, the camel farming/production, the marketing/selling, their meat processing (slaughtering & butchering) and the camel products consumption. There are many hygienic gaps in the camel value chain that pose high risk of infectious/zoonotic disease emergence and spread. Further investigations and risk analysis studies are warranted to provide a practical and hygienic monitoring system to halt risk of disease emergence and spread.

 

 FAO and MERS-CoV

  • 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 558 camel sera and 558 nasal swabs have been collected so far;
    • Most recently, 378 camel sera and nasal swabs were collected during seven rounds of sampling at Abo Simble quarantine station, Aswan Governate.
  • 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.
  • The Viroscience Department at the Erasmus Medical Center will organize a 5-day training course on the molecular and serological detection of MERS-CoV from September-23-28, 2018. ECTAD Egypt will support the attendance and participation of three lab personnel from Animal Health Research Institute (AHRI).

Ethiopia

  • As part of the longitudinal surveillance study and during the reporting period:
    • 366 camel sera and 676 camel nasal swab samples have been collected from three sampling locations of the Amibara district (Melka Sedi, Angelele and Andido) by the NAHDIC field team;
    • 450 camel sera and 900 camel nasal swab samples have been collected from three sampling locations of Yabelo district (Areri, Dikale and Harowoyu) by the NAHDIC field team; and
    • Additionally, 118 camel sera and 294 camel nasal swab samples have been collected by field team from two kebeles of the Amibara district (Halaydege and Bedhamo) by field teams from the CVMA-AAU
  • Preparation are underway for shipment of 1580 camel nasal swab samples to the University of Hong Kong (HKU);
  • In addition to the six upE and 1 orf1a positive test results (previously reported), 364/389 camel sera tested (93.6%) had detectable neutralizing antibody to MERS coronavirus tested using the MERS-spike protein pseudoparticle neutralization test;
  • Preparation of field data from the camel production systems, value chains and systems characterization studies for analysis has been completed.

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);
  • Sixteen rounds of sampling have been conducted in the enrolled study herds (pastoral herd and a ranch). Thus far, 1,472 nasal swabs and sera have each been 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;
    • Nasal swabs are tested using RT-PCR at the laboratory of JUST university while serum samples are tested using ELISA at central veterinary laboratories of Ministry of Agriculture in the framework of capacity building.
  • Data analysis is underway;
  • A camel value chain study was accepted and published in Global Veterinaria 20 (3): 144-152, 2018 ISSN 1992-6197 © IDOSI Publications, 2018 under title "Analysis, Description and Mapping of Camel Value Chain in Jordan". Authors: Sameeh M. Abutarbush, Zaidoun S.K. Hijazeen, Rachel Doodeen, Majid Hawawsheh, Wafaa Ramadneh and Mahmoud Al Hanatleh, this is considered as the first study done in Jordan.

 

Press Releases

 

 Important links