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ARCHIVE MERS-CoV situation update

16 May 2018, 17:00 hours; Rome

The next update will be issued on 20 June 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: 2,206 cases confirmed; including 820 case fatalities (since September 2012)3.
Countries with published animal findings (serology and/or virology): Bangladesh, Burkina Faso, 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.

 

 Situation in humans

  • Between 18 April and 16 May 2018, seven (n=7) new human cases have been reported in Saudi Arabia, including two fatalities (n=2).
    Note: Detailed information from seven (n=7) new cases, including six (n=6) fatalities, is pending and therefore not included in Figures 1 and 2.

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 1,832 13/06/2012 13/05/2018
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 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 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 (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

  • Dan Davida, Ditza Rotenberga, Evgeny Khinicha, Oran Erstera, Svetlana Bardensteina, Michael van Stratenb, Nisreen M.A. Okbac, Stalin V. Rajc, Bart L. Haagmansc, Marcelo Miculitzkid, Irit Davidsona. Middle East respiratory syndrome coronavirus specific antibodies in naturally exposed Israeli llamas, alpacas and camels. One Health, Volume 5, 2018 ,P65-68, ISSN 2352-7714. [reference]. Thus far, no human MERS-CoV infections have been reported from Israel. Evidence for the circulation of MERS-CoV in dromedaries has been reported from almost all the countries of the Middle East, except Israel. Therefore, a total of 411 camel, 102 alpaca and 19 llama sera were tested for the presence of MERS-CoV antibodies. Study findings indicate a lower MERS-CoV seropositivity among Israeli dromedaries than in the surrounding countries, and for the first time naturally infected llamas were identified. In addition, nasal swabs of 661 camels, alpacas and lamas, obtained from January 2015 to December 2017, were tested for the presence of MERS-CoV RNA and all nasal swabs were negative, indicating no evidence for MERS-CoV active circulation in these camelids during that time period.
  • Harrath R, Duhier FMA. Sero-prevalence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) specific antibodies in Dromedary Camels in Tabuk, Saudi Arabia. J Med Virol. 2018 Apr 16. doi: 10.1002/jmv.25186. [reference]. A primary sero-prevalence study of MERS-CoV preexisting neutralizing antibodies in dromedary camel serum was conducted in Tabuk, western north region of KSA, in order to assess the seropositivity of these animals and to explain their possible role in the transmission of the infection to humans. One hundred seventy one (171) serum samples were collected from apparently healthy dromedary camels with different ages from both genders in Tabuk city and tested for specific serum IgG by ELISA. One hundred forty four (144; 84,21%) sera showed presence of protein-specific antibodies against MERS-CoV. These results may provide evidence that MERS-CoV has previously infected dromedary camels in Tabuk and may support the possible role of camels in the human infection.
  • Javad Aghazadeh-Attari, Iraj Mohebbi, Behnam Mansorian, Jamal Ahmadzadeh, Mohammad Mirza-Aghazadeh-Attari, Kazhal Mobaraki, and Sima Oshnouei.  Epidemiological factors and worldwide pattern of Middle East respiratory syndrome coronavirus from 2013 to 2016. Int J Gen Med. 2018; 11: 121–125. Published online 2018 Apr 6. doi:  10.2147/IJGM.S160741 [reference]. This study was conducted to investigate epidemiological factors and patterns related to MERS-CoV disease. Demographic and clinical information, global distribution status, potential contacts, and probable risk factors for the mortality of laboratory-confirmed MERS-CoV human cases were analyzed by following standard statistical methods. Details of 1,094 laboratory-confirmed human cases were recorded, including 421 related deaths. Significant differences were observed in the presentation of the disease from year to year, and all studied parameters differed during the years under study as well.
  • Luo CM1, Wang N, Yang XL, Liu HZ1, Zhang W, Li B, Hu B, Peng C, Geng QB, Zhu GJ, Li F, Shi ZL.  Discovery of novel bat coronaviruses in south China that use the same receptor as MERS coronavirus. J Virol. 2018 Apr 18. pii: JVI.00116-18. doi: 10.1128/JVI.00116-18. [reference]. In this study, out of 1059 bat samples collected in different regions in south China, 89 novel lineage C betacoronaviruses (BetaCoVs) in eight bat species were discovered and two full-length genomes isolated from the great evening bat sequenced. Study results provides the evidence of a MERS-related CoV derived from the great evening bat that uses the same host receptor as human MERS-CoV and thus expands the potential host range of MERS-related CoVs.
  • Ariful Islam, Jonathan H. Epstein, Melinda K. Rostal, Shariful Islam, Mohammed Ziaur Rahman, Mohammed Enayet Hossain, Mohammed Salim Uzzaman, Vincent J. Munster, Malik Peiris, Meerjady Sabrina Flora, Mahmudur Rahman, and Peter Daszak. Middle East Respiratory Syndrome Coronavirus Antibodies in Dromedary Camels, Bangladesh, 2015. DOI: https://doi.org/10.3201/eid2405.171192 [reference]. During the September–October 2015 festival of Eidul-Adha, samples of 36 dromedary camels at an urban farm and 19 camels and 18 fat-tailed sheep at an urban market in the capital city of Dhaka were collected and tested for coronaviruses. All specimens tested negative for coronaviruses, including MERS-CoV, by PCR. ELISA showed 98.6% specificity and sensitivity compared with the pseudoparticle neutralization test. We detected MERS-CoV antibodies in 31% (95% CI 19%–45%) of camels, while all sheep serum samples were negative for MERS-CoV antibodies. Imported camels had a significantly higher seroprevalence (52% [95% CI 33%–70%]) than domestically bred camels. The study concluded that improved surveillance of camels along camel trade routes, camel herds in Dhaka, and persons who have close contact with camels will help assess the transboundary movement and the risk for zoonotic transmission in Bangladesh. 

 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

Egypt

  • Implementation of the repeat cross-sectional surveillance study is underway:
    • The third round of sampling of resident camels in villages of El Wadi El Gadid and Sohag Governorates started. Thus far, a total of 292 sera and 292 nasal swabs were collected in these governorates.
    • The first round of sampling has been carried out in Giza Governorate where a total of 58 sera and 58 nasal swabs were collected. 
    • In addition, 33 sera and 33 nasal swabs from Berkash market (Giza governorate), 13 camel sera and 13 nasal swabs from El Basaten slaughterhouse (Cairo governorate) were collected. 
    • All samples were jointly collected by the General Organization for Veterinary Services (GOVS) and the Animal Health Research Institute (AHRI) before being sent to AHRI for testing, which is currently ongoing.

Ethiopia

  • The first batch of 389 camel sera and 949 camel nasal swab samples have been shipped and delivered to the University of Hong Kong. These samples from the ongoing surveillance study will undergo confirmatory testing after being previously screened at the National Animal Health Diagnostic and Investigation Center (NAHDIC);
  • Sample collection under the longitudinal surveillance (cohort and repeated cross-sectional) has continued from six sampling locations of the Afar and Oromia regional states. Five rounds of sample collection were conducted in April 2018.
  • Thus far, a total of 950 camel sera and 1758 camel nasal swab samples have been collected and stored at NAHDIC. Additionally, 30 camel sera and 60 nasal swab samples have been collected from 30 cohort camels by the College of Veterinary Medicine and Agriculture (CVMA) and are stored at the Ethiopian Public Health Institute (EPHI);
  • Sample collection teams from NAHDIC and CVMA are conducting field activities in Amibara District.

Kenya

  • Implementation of the longitudinal studies is underway:
    • Four rounds of sampling have been conducted in April and May 2018 in the enrolled study herds. To this effect, 180 nasal swabs and 180 sera have been collected from dromedaries.
    • 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). Furthermore, arrangements are underway to send nasal swabs for RT-PCR testing to the  Institute of Virology, Charite, Berlin, Germany.

Press Releases

 Important links