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ARCHIVE MERS-CoV situation update

21 February 2018, 17:00 hours; Rome

The next update will be issued on 21 March 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 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: 2,172 cases confirmed; including 813 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

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 17 January and 21 February2018, twenty-six (n=26) new human cases have been reported in Saudi Arabia, including six fatalities (n=6).
    Note: Detailed information from nine (9) new cases, including four (4) fatalities is still awaited; these could therefore not be 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 1,799 13/06/2012 20/02/2018
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 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 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
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. Data not displayed prior to July 2015 as a result of inconsistent collection of human epidemiological data before this date.

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

 

 Recent publications

  • Kasem S, Qasim I, Al-Doweriej A, Hashim O, Alkarar A, Abu-Obeida A, Saleh M, Al-Hofufi A, Al-Ghadier H, Hussien R, Al-Sahaf A, Bayoumi F, Magouz A.  The prevalence of Middle East respiratory Syndrome coronavirus (MERS-CoV) infection in livestock and temporal relation to locations and seasons. J Infect Public Health. 2018 Jan 29. pii: S1876-0341(18)30005-4. doi: 10.1016/j.jiph.2018.01.004. [reference]. A total of 698 nasal swabs were collected from animals in livestock markets (Jeddah, Al-Gandria, Al-Toki, Arar and Najran) and in the South Riyadh slaughterhouse and examined with Rapid assay and rtRT-PCR. Ten MERS-CoV positive samples were subjected to full genomic sequencing. The results showed a high percentage of dromedaries (56.4%) with evidence for nasal MERS-CoV infection. Phylogenetic analysis of the ten MERS-CoV isolates showed that the sequences were closely related to the other MERS-CoV strains recovered from camels and human cases in the country. Moreover, the results showed that 195 samples were positive for MERS-CoV by rapid assay compared to 394 positive samples of rtRT-PCR, which showed low rapid assay sensitivity (49.49%), while the specificity was found to be 100%.
  • Menachery VD, Schäfer A, Burnum-Johnson KE, Mitchell HD, Eisfeld AJ, Walters KB, Nicora CD, Purvine SO, Casey CP, Monroe ME, Weitz KK, Stratton KG, Webb-Robertson BM, Gralinski LE, Metz TO, Smith RD3, Waters KM, Sims AC, Kawaoka Y, Baric RS. MERS-CoV and H5N1 influenza virus antagonize antigen presentation by altering the epigenetic landscape. Proc Natl Acad Sci U S A. 2018 Jan 30; 115(5): E1012–E1021. Published online 2018 Jan 16. doi: 10.1073/pnas.1706928115, PMCID: PMC5798318 [reference]. Convergent evolution dictates that diverse groups of viruses will target both similar and distinct host pathways to manipulate the immune response and improve infection. In this study, researchers sought to leverage this uneven viral antagonism to identify critical host factors that govern disease outcome. The study results indicate a common mechanism utilized by H5N1-VN1203 and MERS-CoV to modulate antigen presentation and the host adaptive immune response.

 

 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

  • Descriptive analysis was performed for all data collected so far under both cross sectional and longitudinal surveillance studies.
  • A technical meeting was organized on 13 February 2018 on FAO premises with Government partners such as the General Organization for Veterinary Services (GOVS) and the National Laboratory Animal Health Research Institute (AHRI) to discuss planned project activities, including a revised surveillance plan. It was agreed to conduct 2 repeat cross-sectional surveillance studies in the current year. One study will be carried out in 10 different locations distributed over 6 governorates where importation, marketing or slaughtering take place; the other study will target resident camels of 46 villages in 17 Governorates; every month 5 villages will be visited and sampled weekly.
  • An anthropological study will be conducted at the same sites as the camel surveillance, to identify risk factors (e.g. exposures, behaviours, practices) that could facilitate human exposure to MERS-CoV virus. The study design was discussed with an international expert.
  • Ongoing LOA with the national lab Animal Health Research Institute (AHRI) to provide support to conduct repeated cross-sectional surveillance of MERS-CoV in dromedary camels in Egypt: sample collection will be jointly implemented by GOVS and AHRI; the latter will also be responsible for testing.

Ethiopia

  • The first round of MERS CoV longitudinal and repeated cross-sectional surveillance has been completed in the Amibara District of the Afar Regional State. 306 nasal swabs and 85 serum samples were collected from three kebeles (Angelele, Andido and Kusra). Duplicate nasal swabs were collected from each individual camel while serum samples were aliquoted into duplicates overnight.
  • The NAHDIC team currently conducts the first round of repeated cross-sectional surveillance in the Yabelo District of the Oromia Regional State; Two NAHDIC staff (one for the Amibara District and the other for the Yabelo District) who are attending Master’s degree studies at the Addis Ababa University will utilize the study for fulfilment of their graduation research work.
  • The terms of agreement for the implementation of a joint human and camel MERS-CoV surveillance study in additional kebeles (Halaydege and Bedhamo) of the Amibara District has been finalized with the Addis Ababa University. A PhD student will be involved.
  • One ECTAD staff participated at the Prince Mahidol Award Conference (PMAC) 2018, in Bangkok, Thailand from 29 January – 3 February 2018 and presented two poster presentations on the outputs of the previous study and proposed upcoming activities;
    1. Cross-sectional surveillance for Middle East Respiratory Syndrome Coronavirus in Camels and Associated Livestock in Ethiopia; and
    2. Harmonization and flexibility in a multi-country project FAO MERS-CoV surveillance in camels (On behalf of the FAO HQ).
  • Field data collection for the value chain and production systems characterization has been recently finalized from the Arero area of the Oromia Regional State.

Jordan

  • The MERS-COV longitudinal surveillance plan (phase 3) was developed.
  • All MERS-CoV data of phase 1 and 2 were compiled and shared with FAO HQ for global analysis.

Kenya

  • Testing and analysis of samples collected during the previous project cycle (2016/2017) has been finalized. Serological testing of the samples was conducted at the Central Veterinary Laboratories (CVL) in Kenya, while molecular analysis was conducted at the Institute of Virology (Charité, Berlin), Germany.
  • Results revealed that sero-prevalence of MERS-CoV infection was 61% (n=1421) among the camels sampled during the cross-sectional studies. Furthermore, five PCR positive camels were identified in two herds. Genome sequencing of two out of the 5 PCR positive samples confirmed that the MERS-CoV virus circulating in Kenya is similar to that identified in Egypt and in Nigeria (not clade A and not clade B); but it is different from the virus causing human outbreaks in the Middle East and elsewhere. Though there were some sero-positive findings, no virus was detected during the prospect follow-up study (cohort) conducted in a selected ranch.
  • Findings were discussed by the national MERS-CoV technical working group (TWG) at a meeting convened by the Director of Veterinary Services (DVS) on 29 January 2018.
  • Data cleaning, analysis and drafting of a manuscript is underway. A manuscript entitled Mapping potential amplification and transmission hotspots for MERS-CoV, Kenya has been accepted for publication in the Eco-Health Journal.
  • Preparation is underway to undertake further studies. An implementation strategy has been developed to conduct more prospect follow-up (cohort) studies during the current project cycle (2018/2019). The study will be conducted in two selected camel herds and the sampling frequency will be every 10 days with the aim to detect and understand virus dynamics within these herds. The study will commence in March 2018.

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