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ARCHIVE MERS-CoV situation update

16 October 2019, 17:00 hours; Rome

The next update will be issued on 20 November 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: 2,474 cases confirmed; including 889 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), Senegal, Somalia, Spain (Canary Islands), Sudan, Tunisia, Uganda, 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 18 September and 16 October 2019, ten (n=10) new human cases have been reported in Saudi Arabia, including one (n=1) fatality.

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

Map of MERS-CoV livestock field surveys by country
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 2 083 13/06/2012 13/10/2019
United Arab Emirates 87 19/03/2013 04/05/2018
Jordan 28 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 24 26/10/2013 20/02/2019
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 3 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 2 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 January 2015)
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

  • Gardner EG, Kiambi S, Sitawa R, Kelton D, Kimutai J, Poljak Z, Tadesse Z, Von Dobschuetz S, Wiersma L, Greer AL. Force of infection of Middle East respiratory syndrome in dromedary camels in Kenya. Epidemiol Infect. 2019 Sep 24;147:e275.doi: 10.1017/S0950268819001663. PubMed PMID: 31547888. [reference] This study estimated the force of infection (FOI) of MERS-CoV in camel populations from age-stratified serological data. A cross-sectional study of MERS-CoV was conducted in Kenya from July 2016 to July 2017. FOI provides an indirect estimate of infection risk, which is especially valuable where direct estimates of incidence and other measures of infection are challenging to obtain. The FOIs estimated in this study provide important insight about MERS-CoV dynamics in the reservoir species, and contribute to our understanding of the zoonotic risks of this important public health threat.
  • So RTY, Chu DKW, Miguel E, Perera RAPM, Oladipo JO, Fassi-Fihri O, Aylet G, Ko RLW, Zhou Z, Cheng MS, Kuranga SA, Roger FL, Chevalier V, Webby RJ, Woo PCY, Poon LLM, Peiris M. Diversity of dromedary camel coronavirus HKU23 in African camels revealed multiple recombination events among closely related Betacoronaviruses of the subgenus Embecovirus. J Virol. 2019 Sep 18. pii: JVI.01236-19. doi: 10.1128/JVI.01236-19. [reference] In this study authors sequenced multiple complete genomes of dromedary camel coronavirus HKU23 (DcCoV-HKU23) from Nigeria, Morocco and Ethiopia and identified several genomic positions indicative of cross species virus recombination events among other Betacoronaviruses of the subgenus Embecovirus (clade A β-CoVs). The results highlight active recombination of coronaviruses circulating in dromedaries, providing insight on the emergence and evolution of other Betacoronaviruses including MERS-coronavirus (MERS-CoV).

 

 FAO and partners

  • The OIE Scientific Commission reviewed the assessment performed by the ad hoc Group on MERS-CoV and the justification provided, and agreed that MERS-CoV in dromedary camels matched criteria 1, 2, 3 and 4a of the Terrestrial Code Chapter 1.2. The Scientific Commission advised MERS-CoV be added to the OIE list and recommended the Code Commission to amend the Terrestrial Code Chapter 1.3 [reference].
  • 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

  • The repeat cross-sectional surveillance study for 2019 started on 22 April with joint missions by the General Organization for Veterinary Services (GOVS) and Animal Health Research Institute (AHRI) to Abo-Simble Quarantine Station, Aswan Governorate: The 15 missions collected 810 camel sera and 810 nasal swabs. All samples were received by AHRI for further testing.
  • Following the training for MERS-CoV slaughterhouse sampling organized July 2019 with technical support from FAO Headquarters, GOVS/AHRI applied the optimized sampling practices to reach the turbinate respiratory epithelium in live camels. As of 26 August, three samples are collected from each animal i.e. serum, nasal and rectal swabs. During the seven sampling missions performed since, 378 rectal swabs were collected in addition to the conventional samples.
  • The on-going LOA with AHRI, covering sample collection and testing, was extended until the end of 2019.
  • A national consultative meeting was conducted on 9 October to discuss the major outputs, achievements, challenges, success stories and lessons learnt for the MERS-CoV project, implemented in Egypt since 2016 as part of the USAID-funded Emerging Pandemic Threats Programme in its Phase 2 (EPT-2).

Ethiopia

  • The longitudinal surveillance sample collection is ongoing in 30 cohort camels from the Angelele sampling location of the Amibara District, with a sampling interval of ten days. So far a total of 150 camel sera and 300 camel nasal swab (duplicates taken from each camel) samples have been collected in five rounds.
  • Slaughterhouse camel sample collection (blood, nasal swab, nasal turbinate tissue and retropharyngeal lymph node tissue samples) has continued for a 3rd round. So far 20 blood samples, 40 nasal swab, 20 nasal turbinate tissue and 20 lymph node samples have been collected from 20 camels ante-mortem (blood and nasal swab) and post-mortem (nasal turbinate and lymph node tissue samples).

Kenya

  • A national stakeholder consultation meeting was held on 27 September in Nairobi. The meeting reviewed the outputs, achievements, success stories, lessons learnt, and other crosscutting issues associated with implementation of the EPT-2 programme in Kenya, including the MERS-CoV project.

Jordan

  • MERS-CoV positive samples are undergoing full genome sequencing at Rocky Mountain Labs in Montana, USA.

Press Releases

 

 Important links