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ARCHIVE MERS-CoV situation update

22 November 2017, 17:00 hours; Rome

The next update will be issued on 20 December 2017

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 Organisatwion 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: 2,117 cases confirmed; including 789 case fatalities (since September 2012)3.
Countries with published animal findings (serology and/or virology): Burkina Faso, Egypt, Ethiopia, Iran, 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

  • MERS-CoV in camelidae in Saudi Arabia was reported to the OIE on 8 November 2017. Testing was performed on 4 October 2017. Two out of four animals at a farm in Buraydah, Al Quasim and three out of eight animals at a farm in Taif, Makkah tested positive [reference].

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 25 October and 22 November 2017, seventeen (n=17) new human cases have been reported: sixteen (n=16), including seven fatalities (n=7) in Saudi Arabia, and one (n=1) case in Oman.

Map 2. Global distribution of human cases of MERS-CoVMap 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 1,746 13/06/2012 20/11/2017
United Arab Emirates 86 19/03/2013 11/08/2017
Jordan 26 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 10 26/10/2013 01/11/2017
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 1 08/04/2014 08/04/2014
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
Click to enlarge

Figure 2. Breakdown of human MERS-CoV cases by potential source of exposure (in percent). 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.

Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Click to enlarge

 

 Recent publications

  • Fukushi S, Fukuma A, Kurosu T, Watanabe S, Shimojima M, Shirato K, Iwata-Yoshikawa N, Nagata N, Ohnishi K, Ato M, Melaku SK, Sentsui H, Saijo M. Characterization of novel monoclonal antibodies against the MERS-coronavirus spike protein and their application in species-independent antibody detection by competitive ELISA. J Virol Methods. 2018 Jan;251:22-29. doi: 10.1016/j.jviromet.2017.10.008. [reference] In this study, novel MAbs against the spike protein of MERS-CoV were produced and characterized. The MAb-based cELISA was validated using sera from Ethiopian dromedary camels. Relative to the neutralization test, the cELISA detected MERS-CoV-specific antibodies in 66 Ethiopian dromedary camels with a sensitivity and specificity of 98% and 100%, respectively. This cELISA may be useful for MERS epidemiological investigations on MERS-CoV infection
  • Alhetheel A, Altalhi H, Albarrag A, Shakoor Z, Mohamed D, El-Hazmi M, Somily A, Barry M, Bakhrebah M, Nassar M. Assessing the Detection of Middle East Respiratory Syndrome Coronavirus IgG in Suspected and Proven Cases of Middle East Respiratory Syndrome Coronavirus Infection. Viral Immunol. 2017 Nov;30(9):649-653. doi: 10.1089/vim.2017.0091. [reference] In this study, the authors evaluated the detection of MERS-CoV-IgG in suspected and proven cases of human MERS-CoV infection. All subjects underwent MERS-CoV RNA and MERS-CoV-IgG testing. Based on the lack of correlation between nucleic acid and serological analysis, it was concluded that MERS-CoV-IgG testing may not be suitable for diagnosing acute infection or estimating its prevalence during an outbreak. In addition, the findings show that MERS-CoV-IgG may not have significant value in determining disease severity or prognosis.
  • Zhou J, Li C, Zhao G, Chu H, Wang D, Yan HH, Poon VK, Wen L, Wong BH, Zhao X, Chiu MC, Yang D, Wang Y, Au-Yeung RKH, Chan IH, Sun S, Chan JF, To KK, Memish ZA, Corman VM, Drosten C, Hung IF, Zhou Y, Leung SY, Yuen KY. Human intestinal tract serves as an alternative infection route for Middle East respiratory syndrome coronavirus. Sci Adv. 2017 Nov 15;3(11):eaao4966. doi: 10.1126/sciadv.aao4966. [reference] This study demonstrated that human primary intestinal epithelial cells, small intestine explants, and intestinal organoids were highly susceptible to MERS-CoV and can sustain robust viral replication. It also identified evidence of enteric MERS-CoV infection in the stool specimen of a clinical patient. With the progression of the enteric infection, inflammation, virus-positive cells, and live viruses emerged in the lung tissues, indicating the development of sequential respiratory infection. Taken together, these data suggest that the human intestinal tract may serve as an alternative infection route for MERS-CoV.
  • Yusof MF, Queen K, Eltahir YM, Paden CR, Al Hammadi ZMAH, Tao Y, Li Y, Khalafalla AI, Shi M, Zhang J, Mohamed MSAE, Abd Elaal Ahmed MH, Azeez IA, Bensalah OK, Eldahab ZS, Al Hosani FI, Gerber SI, Hall AJ, Tong S, Al Muhairi SS. Diversity of Middle East respiratory syndrome coronaviruses in 109 dromedary camels based on full-genome sequencing, Abu Dhabi, United Arab Emirates. Emerg Microbes Infect. 2017 Nov 8;6(11):e101. doi: 10.1038/emi.2017.89. [reference] The camel MERS-CoV genomes from this study represent 3 known and 2 potentially new lineages within clade B. Within lineages, diversity of camel and human MERS-CoV sequences are intermixed. Evidence suggests MERS-CoV infection in humans results from continued introductions of distinct MERS-CoV lineages from camels. This hypothesis is supported by the camel MERS-CoV genomes sequenced in this study.
  • Ewer K, Sebastian S, Spencer AJ, Gilbert S, Hill AVS, Lambe T. Chimpanzee adenoviral vectors as vaccines for outbreak pathogens. Hum Vaccin Immun other. 2017 Oct 30:1-13. doi: 10.1080/21645515.2017.1383575. [referenceDrivers, strategies and practical considerations for developing vaccines against outbreak pathogens are discussed. Chimpanzee adenoviral (ChAd) vectors have been developed as vaccine candidates for multiple infectious diseases and prostate cancer. Such viral vectors provide an attractive platform for stockpiling vaccines for emergency deployment in response to a threatened outbreak of an emerging pathogen. Progress on these approaches is detailed, particularly for Lassa fever, Nipah and MERS-CoV.

 

 FAO and MERS-CoV

  • 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

Kenya

  • Longitudinal surveillance (cohort study) is ongoing at Soysambu Ranch in Nakuru County. Nine rounds of sampling have been conducted. Testing is ongoing at the country’s Central Veterinary Laboratories (CVL). 
  • Longitudinal surveillance (repeat cross sectional studies) ongoing in Isiolo County; four rounds of sampling have been conducted so far and testing is ongoing at CVL.
  • Kenya shipped 2,240 nasal swabs to the Institute of Virology, Charité – Universitätsmedizin Berlin, Germany for molecular analysis. These include 59 nasals swabs from other species (sheep, donkey, cattle and cattle).

Ethiopia

  • On 16 – 17 November 2017 ECATD Ethiopia conducted a national stakeholders workshop on the upcoming longitudinal surveillance study in the presence of 25 participants from the NAHDIC, Ministry of Health, regional animal health bureaus and laboratories, Universities and partners such as the CDC, WHO, P&R, OHWF and OSU. The workshop was also attended by Dr. Heba Mahrous from the FAO HQ and deputy team leader and experts from the ECTAD Ethiopia. 
  • On 20 - 21 November 2017 ECTAD Ethiopia hosted a planning meeting for ECTAD MERS-CoV focal points. ECTAD MERS-CoV project coordinators from Egypt, Kenya, Ethiopia and the focal point from FAO HQ came together to revise the country specific work plans for the upcoming year (up to September 2018) based on the recommendations from the recently held FAO-OIE-WHO tripartite meeting in Geneva. 

Egypt

  • Repeated cross-sectional surveillance rounds are delayed and hopefully recommence soon; samples will be collected form 46 villages and stored at the Animal Health Research Institute (AHRI) lab to be analysed upon receiving kits and reagents.
  • The new MERS project work plan (for 2017-2018) had been drafted to focus on understanding the infection and transmission dynamics of the virus as well as risk factors for human exposure to MERS-CoV associated with behaviour, practices and socio-economic aspects.

Press Releases

  • 25-27 September 2017: FAO-OIE-WHO Global Technical Meeting on MERS-CoV [#tackleMERS]
  • 13-14 December 2016: FAO inter-regional training workshop: “Analysis of camel value chains and human behaviours in view of MERS-CoV surveillance”.
  • 7 November 2016: FAO_ECTAD Egypt trains Laboratory staff from Animal Health Research Institute (AHRI) and the National Research Center (NRC) on lab tests for (MERS-CoV).
  • 30 March 2016: Launching of the “Reference Centre and Network on camel diseases” for the Gulf and neighbouring countries. (in Arabic)
  • 28 January 2016: FAO pushes for a road map to control and contain zoonotic diseases.
  • 21 to 22 January 2016: Technical Meeting: Understanding MERS-CoV at the animal-human interface at FAO-HQ in Rome, Italy.
  • 20 October 2015: U.S. backs FAO efforts to combat global animal disease threats with $87 million.
  • 27 April 2015: Stepping up efforts for a better understanding of MERS at the human-animal interface.

 Important links