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ARCHIVE MERS-CoV situation update

17 April 2019, 17:00 hours; Rome

The next update will be issued on 22 May 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: 2,421 cases confirmed; including 870 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 20 March and 17 April 2019, twenty-four (n=24) new human cases have been reported in Saudi Arabia, including seven (n=7) fatalities. Eleven (n=11) of these cases are related to the ongoing human cluster in Al-Khafji, Eastern Province, Saudi Arabia.

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

Map 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 2 031 13/06/2012 13/04/2019
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 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 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 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

  • Mubarak A, Alturaiki W and Hemida M. Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Infection, Immunological Response, and Vaccine Development. Journal of Immunology Research Volume 2019, Article ID 6491738, 11 pages. [Reference]. This review article highlights current knowledge of both innate and adaptive immune responses to MERS-CoV and the current state of MERS-CoV vaccine development. The authors recommend designing a vaccine that enhances the induction of strong immunity via the intra-nasal route to block MERS-CoV infection.
  • Farag E, Nour M, Islam M, Mustafa A, Khalid M, Sikkema R, Alhajri F, Bu-Sayaa A, Haroun M, Van Kerkhove M, Elkholy A, Mamunur S, Malik R, Reusken C, Koopmans M and AlHajri M. Qatar experience on One Health approach for middle-east respiratory syndrome coronavirus, 2012–2017: A viewpoint. One Health, Volume 7, June 2019. [Reference]. This review described how the One Health approach was used in surveillance and response to MERS-CoV in Qatar during the period 2012 to 2017. The authors concluded that lack of sufficient technical guidance on veterinary surveillance and poor risk perception among the vulnerable population constituted major obstacles to maintain systematic One Health performance, and recommended that a regional ‘One Health Centre of Excellence’ would help to develop unified standards and integrative guidelines for control of zoonoses, including MERS-CoV.
  • Kahlout R, Nasrallah G, Farag E, Wang L, Lattwein E, Marcel A, Zowalaty M, Romaihi H, Graham B, Al Thani A and Yassine H. Comparative Serological Study for the Prevalence of Anti-MERS Coronavirus Antibodies in High- and Low-Risk Groups in Qatar. Journal of Immunology Research, Volume 2019, Article ID 1386740, 8 pages. [Reference]. The aim of this study is to evaluate the performance of various serological assays (ELISA, IIFT and ppNT) and to estimate the seroprevalence of anti-MERS-CoV antibodies in high- and low-risk groups in Qatar. A total of 4858 samples were screened, including 4719 samples collected from healthy blood donors over a period of five years (2012-2016), 135 samples from baseline case contacts collected from individuals in close contact with three positive PCR-confirmed patients, and four samples from MERS-CoV confirmed patients. The authors report a low prevalence of anti-MERS antibodies in the general population, and highlight that all IgG rS1-ELISA-reactive samples from blood donors exhibited considerable reactivity to the four circulating human coronaviruses (HKU1, OC43, 229E, and NL63). A surprising finding is that one out of thirteen (7.7%) randomly selected IgG rS1-ELISA-negative blood donor samples was reactive in the IgM-IIFT (but not the IgG-IIFT) and subsequently confirmed by ppNT.
  • Khudhair A, Killerby E, Al Mulla M, Abou Elkheir k, Ternanni w, Bandar Z, Weber S, Khoury M, Donnelly G, Al Muhairi S, Khalafalla A, Trivedi S, Tamin A, Thornburg N, Watson J, Gerber S, Al Hosani F and Hall A. Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014–2017. EID Journal, Volume 25, Number 5—May 2019. [Reference]. In this study MERS-CoV seroprevalence was assessed among 100-235 workers in two slaughterhouses and one live-animal market during three sampling rounds in Abu Dhabi, United Arab Emirates, during 2014–2017. ELISA and MNT results showed that seroprevalence ranged from 6-19 percent. Associations between risk factors and seropositivity is described.

 FAO and partners

  • 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

  • During the first week of April, the General Organization Veterinary Services (GOVS) and FAO discussed the proposed update for the MERS-CoV surveillance plan; as agreed, the first round of Quarantine sampling will start on 22 April 2019 at Abo-Simble Quarantine Station (Aswan Governorate).
  • A new LOA was signed with the Animal Health Research Institute (AHRI) aiming to:
    • Support conducting the 2019 surveillance studies for MERS-CoV in Dromedary Camels in Egypt; sample collection will be done jointly by GOVS and AHRI, the latter will be responsible for the testing.
    • Re-test the samples collected during the previous longitudinal study in 2018 (see below).
  • Serology results from the cohort study conducted in 2018 will be confirmed by the Animal Health Research Institute (AHRI) with a quantitative ELISA method developed by the Erasmus Medical Centre, the Netherlands. The Erasmus Viroscience Department will provide materials and guidance to perform the test at AHRI.

Ethiopia

  • A consignment of 128 camel sera and 256 camel nasal swab samples was shipped to the University of Hong Kong on 27 March 2019 for serologic and molecular testing and phylogenetic analysis of positive samples. The samples were collected from a cohort of 15 camels from two sampling locations of the Amibara District of the Afar Regional State.
  • Field testing of the WHO/FAO developed ”General Population Study” questionnaires was performed in Sebeta, Addis Ababa and Bishoftu during the week 25-29 March 2019. So far, 38 individuals were tested. Feedback will be provided to the WHO/FAO MERS-CoV working group by the end of April 2019 once the exercise is completed.

Kenya

  • A training course for the sampling team was conducted from 25 to 29 March 2019 in Garissa Town.
  • Due to the current drought, sampling was postponed from 1 April to 1 May, after the predicted onset of rains that will hopefully result in improved pasture and camel body condition.

Jordan

  • Review and updating of the MERS-CoV surveillance plan (2019) is underway with the Ministry of Agriculture to include surveillance in camel slaughterhouse (collecting turbinate and lymph node specimens) and to conduct a cohort study on selected camel farms.

Press Releases

 

 Important links