Animal Health

MERS-CoV situation update

19 January 2023, 17:00 hours; Rome

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: 2,603 cases confirmed with 935 fatalities (since September 2012)2 . Three new human cases: two (n=2) in Saudi Arabia and one (n=1) in Oman, with no fatalities reported since the last Update (21 December 2022). Please see ‘Situation in humans’ for further details.

Countries with published animal findings (serology and/or virology): Bangladesh, Burkina Faso, 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 shows results of published MERS-CoV livestock field surveys conducted up to 14/02/2022 at country level, over an estimate of dromedary and Bactrian camel distribution density. Circles indicate countries in which field surveys have occurred. Circle size is proportional to the number of studies conducted in each country (see legend). Yellow circles indicate positive findings in animals (antibodies or antigen), while turquoise circles indicate a lack of positive findings. Please note that the circle in Spain indicates positive findings from the Canary Islands. The density map includes dromedary and bactrian camel distribution, and is an unpublished model based on the methodology described in Robinson et al. (2014).

Map 1. MERS-CoV livestock field surveys by country*

MERS-CoV livestock field surveys by country

*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 21 December 2022 and 19 January 2023, three new human cases with no fatalities were reported, two (n=2) in Saudi Arabia and one (n=1) in Oman.

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

Global distribution of human cases of MERS-CoV


Note:
Stars highlight countries reporting human cases since 2020 (Oman, Saudi Arabia, Qatar, and United Arab Emirates).

CountryCumulative number of confirmed
MERS-CoV human cases
First observationLast Observation
Middle East

Saudi Arabia

2 195

13/06/2012

31/12/2022

United Arab Emirates

93

19/03/2013

06/11/2021

Jordan

28

02/04/2012

26/09/2015

Qatar

28

15/08/2013

18/03/2022

Oman

26

26/10/2013

28/12/2022

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

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

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

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)

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

Note: 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: Human Epidemiological Timeline). 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

Zhou, Z., Ali, A., Walelign, E., Demissié, G. F., Masry, I. E., Abayneh, T., Getachew, B., Krishnan, P., Ng, D. Y. M., Gardner, E., Makonnen, Y., Miguel, E., Chevalier, V., Chu, D. K., So, R. T. Y., Von Dobschuetz, S., Mamo, G., Poon, L. L. M., & Peiris, M. (2023). Genetic diversity and molecular epidemiology of Middle East Respiratory Syndrome Coronavirus in dromedaries in Ethiopia, 2017 to 2020. Emerging microbes & infections, 2164218. Advance online publication. https://doi.org/10.1080/22221751.2022.2164218. This study investigated the genetic diversity and molecular epidemiology of MERS-CoV in dromedary camels in Ethiopia from samples collected from 2017-2020. Twenty-five whole genome sequences were obtained. Phylogenetically, these Ethiopian camel-originated MERS-CoV belonged to clade C2, clustering with other East African camel strains. In contrast to clade A and B viruses from the Arabian Peninsula, clade C camel-originated MERS-CoV from Ethiopia had various nucleotide insertions and deletions in non-structural gene nsp3, accessory genes ORF3 and ORF5 and structural gene N. This study demonstrates the genetic instability of MERS-CoV in dromedaries in East Africa.

Country-level actions

Egypt

  • Abattoir-based sampling continued during December 2022. A total of 240 samples (120 deep nasal swabs, and 120 tissues from lymph node) and epidemiological data were collected from 120 camel carcasses from slaughterhouses at Cairo and Giza Governorates . The sampling team was composed of experts from the General Organization for Veterinary Services (GOVS) and the Animal Health Research Institute (AHRI).
  • A research article was prepared and submitted to an international peer review journal on the Longitudinal Study of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Dromedary Camels between December 2019 and March 2020 to characterize the kinetics of MERS-CoV neutralizing antibodies and its relationship with viral shedding.
  • A letter of agreement was signed with the Animal Health Research Institute (AHRI) in Egypt to conduct risk-based surveillance of MERS-CoV, including monitoring for genomic changes.

Ethiopia

  • Field and slaughterhouse sample collection resumed in December 2022. 153 samples (66 nasal swab and 66 serum from field and 7 nasal swab, 7 serum and 7 lymph node tissue samples from slaughterhouse) were collected from 73 camels through LOA collaboration with the National Veterinary Institute (NVI).
  • Epidemiological report for the period 2019 -2020 was completed and shared with FAO Rome for further analysis, review and feedback together with the previously prepared epi report for 2016-2018. Additionally, raw data of the whole surveillance activity and its laboratory results since 2016 were shared.  
  • Proficiency Testing (PT) for MERS-CoV PCR is planned for February 2023. The PT panel is expected to arrive at Addis between 21-24 Jan 2023.
  • Preparation of questionnaires to conduct KAP study on camel respiratory diseases in area/farming system with high MERS-CoV seroprevalence is underway. Data collection will start in February.
  • A research paper on “Genetic diversity and molecular epidemiology of Middle East Respiratory Syndrome Coronavirus in dromedaries in Ethiopia, 2017–2020” was published in Emerging Microbes & Infections (see link under recent publications)
  • Abstract on "Epidemiologic and Genetic characterization of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Ethiopia" has been accepted for presentation at the 3rd Scientific Conference on Acute Respiratory Infections in the Eastern Mediterranean Region ( EMARIS Conference 2023).

Kenya

  • Manuscript on KAP study on camel respiratory conditions in Isiolo and Garissa in October 2020 was published in Veterinary Frontiers in November 8, 2022 [reference].

Jordan

  • Two veterinarians from central veterinary laboratories at the Ministry of Agriculture completed their training on advanced serological diagnostic techniques using pseudo particle neutralization testing (PPNT) at the Erasmus Medical Center from 24 – 28 October in Rotterdam.
FAO and partners
  • The report on the FAO-WOAH-WHO organized “Global tripartite technical meeting on MERS-CoV and other emerging zoonotic coronaviruses” has been published [reference].
  • The Quadripartite has published the One Health Joint Plan of Action (OH-JPA). It provides a framework for action and proposes a set of activities that the four organizations can offer together to enable countries to advance and scale up One Health in managing human, animal, plant and environment health threats [reference].
  • FAO organized a technical workshop on “Qualitative Risk Assessment of MERS-CoV foreign clade introduction to Africa” from July 5 – 6, 2022, hosted by the FAO Egypt office in Cairo. Participants included camel movement experts from different African, Near East, and European countries, as well as FAO MERS-CoV country focal points from Egypt, Ethiopia, Jordan, and Kenya. The final report is underway.
  • FAO publishes a quarterly situation updates on SARS-CoV-2 in animals [reference].
  • FAO published recommendations for the epidemiological investigation of SARS-CoV-2 in exposed animals [reference], including a supplement on investigating potential recombination of MERS-CoV and SARS-CoV-2 or other coronaviruses in camels. [reference]
  • The Joint Risk Assessment Operational Tool is available in Arabic, Chinese, and Russian. [reference]
  • FAO’s USAID-funded work on MERS-CoV in Jordan, Egypt, Kenya and Ethiopia has been extended to June 2023.
  • A peer-reviewed article was published by the Hong Kong University (HKU) [reference] on genetic and phenotypic characteristics of MERS-CoV isolates sampled from camels in Burkina Faso, Egypt, Ethiopia, Kenya, Morocco, and Nigeria, and compared to viruses isolated in the Arabian Peninsula. FAO, under the EPT-2 project contributed samples taken in Ethiopia and Kenya. The findings highlight the need for enhanced MERS-CoV surveillance in dromedaries and humans in Africa and for measures to avoid introduction of clade B viruses from the Arabian Peninsula to Africa.
  • FAO has published a SARS-CoV-2 qualitative exposure assessment [reference] which provides a comprehensive review of available scientific evidence and assessment of exposure risk from different wild or domestic animal species. Results can inform country-level risk assessments and provide the evidence base for targeted SARS-CoV-2 investigations in animals and mitigation options. The e-book version can be found here: [reference], and the summary is now available in all UN languages. [reference]
  • FAO published an illustrative guideline describing optimized procedures to facilitate swab sampling from the deeper part of the upper respiratory tract inside the camel’s nasal cavity and to collect good quality specimens from slaughtered camels. [ reference]
  • The Tripartite Zoonoses Guide is now available in all UN languages. [reference]
  • In close collaboration with WOAH 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.
Next issue: 16 February 2023
The disease situation updates are produced by the FAO Emergency Prevention System for Animal Health (EMPRES-AH) as part of its mission to increase global disease intelligence.
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 orange. 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 [WOAH]) 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.

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