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ARCHIVE MERS-CoV situation update

19 December 2018, 17:00 hours; Rome

The next update will be issued on 23 January 2019

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 Bahrain.
Findings in humans: 2,277 cases confirmed; including 842 case fatalities (since September 2012)2.
Countries with published animal findings (serology and/or virology): Bangladesh, Burkina Faso, Chile, Egypt, Ethiopia, Iran, Iraq, 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 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 21 November and 19 December 2018, three (n=3) new human cases have been reported in Saudi Arabia, with no 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 1,900 13/06/2012 14/12/2018
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 January 2015)
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

  • Kamau EM., Orinde B and Gitau G. Sero-prevalence of Middle East Respiratory Syndrome Coronavirus among Camels at a Slaughterhouse in Kenya, 2015. Journal of Health Science 6 (2018) 379-383. [Reference]. This study reports high sero-prevalence of MERS-CoV antibodies demonstrated among dromedary camels brought for slaughter to Athi-River slaughterhouse from different regions of Kenya. Proportions were calculated and associations between anti-MERS-CoV antibody sero-positivity and age group, sex, and origin of camels assessed using Chi-square tests. Out of 373 specimens, 53% were from females. The overall antibody sero-prevalence was 82%. Sero-prevalence was not found to differ by age group, sex, or origin.
  • Esther K, Ongus J, Gitau G, Galgalo T,  Lowther SA and Bitek A. Knowledge and practices regarding Middle East Respiratory Syndrome Coronavirus among camel handlers in a Slaughterhouse, Kenya, 2015. Zoonoses and public health J, September 2018. [Reference]. In this study the knowledge and practices regarding MERS among herders, traders and slaughterhouse workers were assessed at AthiRiver slaughterhouse, Kenya. 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. 40% 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 MERSCoV. Use of personal protective clothing to prevent direct contact with discharges and aerosols was lacking. These findings highlight the need to disseminate information about MERSCoV and enhance hygiene and biosafety practices among camel slaughterhouse workers to reduce opportunities for potential virus transmission.
  • Te N, Vergara‐Alert J, Lehmbecker A, Pérez M, Haagmans B, Baumgärtner W, Bensaid A, and Segalés J. Co‐localization of Middle East respiratory syndrome coronavirus (MERS‐CoV) and dipeptidyl peptidase‐4 in the respiratory tract and lymphoid tissues of pigs and llamas. Transboundary and emerging diseases J. 06 December 2018. doi: 10.1111/tbed.13092 [Reference]. In this study the co‐localization of the Middle East respiratory syndrome coronavirus (MERS‐CoV) and its receptor dipeptidyl peptidase‐4 (DPP4) has been investigated across respiratory and lymphoid organs of experimentally MERS‐CoV infected pigs and llamas. Obtained data confirm the role of DPP4 for MERS‐CoV entry in respiratory epithelial cells of llamas. Notably, several nasal epithelial cells in pigs were found to express viral antigen but not DPP4, suggesting the possible existence of other molecule/s facilitating virus entry or down regulation of DPP4 upon infection.
  • Paden CR, Yusof MFBM, Al Hammadi ZM, Queen K, Tao Y, Eltahir YM, Elsayed EA, Marzoug BA, Bensalah OKA, Khalafalla AI, Al Mulla M, Khudhair A, Elkheir KA, Issa ZB, Pradeep K, Elsaleh FN, Imambaccus H, Sasse J, Weber S, Shi M, Zhang J, Li Y, Pham H, Kim L, Hall AJ, Gerber SI, Al Hosani FI, Tong S and Al Muhairi SSM. Zoonotic origin and transmission of Middle East respiratory syndrome coronavirus in the UAE. Zoonoses Public Health. 2018 May;65(3):322-333. [Reference]. In this study, the whole MERS-CoV genomes directly collected from respiratory samples from 23 confirmed human MERS cases in the United Arab Emirates were sequenced. These samples included cases from three nosocomial and three household clusters. Sequence analysis supports the epidemiological data within the clusters, and further, suggests that these clusters emerged independently. To understand how and when these clusters emerged, respiratory samples were taken from dromedary camels in the same geographic regions as the human clusters. Middle East respiratory syndrome coronavirus genomes from six virus-positive animals were sequenced, and these genomes were nearly identical to those found in human patients from corresponding regions.
  • Cabalion S, Abu Baker E,  Al-Romaihi A and  Keck F. Middle East respiratory syndrome coronavirus and human-camel relationships in Qatar. Medicine Anthropology Theory 5 (3): 177–194, 25 Jun 2018. [Reference]. This article investigates camel raising as a risk factor for human exposure to the Middle East Respiratory Syndrome coronavirus (MERS-CoV) and is the first ethnographic description of this practice in Qatar. The authors review available findings from previous research among camel workers in the country, and discuss findings in the context of the recent valorisation of camels as Qatar’s economy shifts from pastoralism to a global trade centre. Challenges encountered during the study included gathering information about camel raising practices in relation to potential zoonotic diseases, given the value attached to camels in Arab societies. The paper suggests that the concentration of camels in farms and central markets after the ban of camel grazing as well as the revival of the tradition of drinking camel milk may have increased the risks of human exposure to MERS-CoV from camels.
  • Kiambi S, Corman V, Sitawa R, Githinji J, Ngoci J, Ozomata A, Gardner E, von Dobschuetz S, Morzaria S, Kimutai J, Schroeder S, Njagi O, Simpkin P, Rugalema G, Tadesse Z, Lubroth J, Makonnen Y, Drosten C, Müller M and Fasina F. Detection of distinct MERS-Coronavirus strains in dromedary camels from Kenya, 2017. Emerging Microbes & Infections volume 7, article number: 195 (2018). [Reference]. Between July 2016 and October 2017, a total of2175 nasal swab samples were collected from dromedary camels. Five samples confirmed positive for MERS-CoV nucleic acid detection, four of them from females or <1 year old animals, consistent with previous observations that juvenile dromedaries and possibly females may be the main sources for MERS-CoV excretion. The MERS-CoV RNA-positive animals belonged to two different dromedary camel herds, both located within Isiolo country. Full genome sequences were generated for one specimen of each of the two positive herds. Both Kenyan dromedary MERS-CoV isolates clustered with the proposed clade C viruses from Ethiopia and Egypt in a sister relationship to all Arabian MERS-CoVs (clades A and B). The two Kenyan MERS-CoV isolates diverged by 0.02% at the nucleotide level, confirming the circulation of at least two different MERS-CoV strains in Kenya. The next closest MERS-CoV relative was obtained from a dromedary sampled in Egypt in 2014 (NRCE-NC163/2014; Acc No. KU74020, clade C) and showed 0.23–0.24% nucleotide distance. Recombination analysis by RDP V4.95 indicated that none of the two Kenyan MERS-CoV strains had recombined with any of the known clade A, B, or C strains.

 

 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:
    • On 12 November, the third and last phase of quarantine sampling started and will continue until mid of January 2019 with two week sampling intervals. In three rounds, 150 camel sera and 150 nasal swabs were collected from Abo-Simble quarantine station (Aswan Governorate).
    • Sample testing by Animal Health Research Institute (AHRI) is ongoing.

Ethiopia

  • Surveillance in Bedhamo and Halaydege sampling locations of the Afar regional state is ongoing.
    • Teams from the College of Veterinary Medicine and Agriculture of the Addis Ababa University (CVMA-AAU) are conducting field sample collection from a cohort of 30 camels from the two sampling locations.
    • 237 camel nasal swab and 119 sera samples have been collected since April 2018 from a cohort of 30 camels (15 each at Bedhamo and Halaydege sites),the samples are being aliquoted at the Ethiopian Public Health Institute (EPHI) for shipment to the University of Hong Kong.
  • Concept note and invitation letters have been prepared and are being sent out to organize a national MERS-CoV consultation of stakeholders and partners (09 – 10 January 2019) with the objective to receive inputs on activities planned for 2020-2021;
  • The University of Hong Kong conducted a quality control check on some of the samples that turned negative for MERS-CoV, to detect dromedary camel genes in the samples. The results indicate that sample transportation, cold chain and lab testing are functional. Two weak positives have been identified. However, due to low viral copy number sequencing could not be conducted.

Kenya

  • The manuscript titled “Detection of distinct MERS-Coronavirus strains in dromedary camels from Kenya, 2017” is published in Emerging Microbes & Infections volume 7, Article number: 195 (2018).
    • Results of 1,000 nasal swab and 495 tracheal swab samples submitted to the Institute of Virology, University of Bonn for molecular analysis (PCR and sequencing) turned out negative.
    • Serological testing of the 1,472 samples at the Central Veterinary Laboratory is complete and subsequent finalization of the 2018 Cohort Follow-up Study report inclusive of laboratory results is underway.

Jordan

  • Implementing of Longitudinal surveillance is ongoing in two locations (Azraq, Ramtha); rounds to collect samples started last week.
  • Nasal swabs and serum samples were collected from 18 camels at Azraq farm and sent to JUST lab and Ministry of Agriculture lab for testing.

 

Press Releases

 

 Important links