Wednesday, July 3, 2013

WHO: Case - control study to assess potential risk factors related to human illness caused by Middle East Respiratory Syndrome Coronavirus (MERS - CoV)

Version  2
Date:  03  July  2013
Contact:  Dr  Anthony  Mounts

This  document  was  adapted  from  a  protocol  developed  by  the  Consortium  for  the  Standardization  for   Influenza  Seroepidemiology  (CONSISE),  a  global  partnership  aiming  to  develop  influenza  investigation   protocols  and  standardize  seroepidemiology  to  inform  public  health  policy  for  pandemic,  zoonotic  and   seasonal  influenza.  This  international  partnership  was  created  out  of  a  need,  identified  during  the  2009   H1N1  pandemic,  for  better  (standardized,  validated)  seroepidemiological  data  to  estimate  infection   attack  rates  and  severity  of  the  pandemic  virus  and  to  inform  policy  decisions.  More  information  on  the   CONSISE  network  can  be  found  on  their  website: 
Protocol  Summary
This  investigation  will  provide  data  to  evaluate  exposures  and  risk  factors  for  human  cases  of  Middle  East   Respiratory  Syndrome  Coronavirus  (MERS-­‐CoV)  to  determine  those  that  are  related  to  infection.  This   protocol  outlines  a  case-­‐control  study  and  the  epidemiological  methods  to  guide  data  collection  to  assess   risk  factors  for  illness  caused  by  MERS  coronavirus  (MERS-­‐CoV)  infection.  Health  care  personnel  and  the   evaluation  of  other  contacts  are  addressed  in  a  separate  protocol.  
Comments  for  the  user’s  consideration  are  provided  in  purple  text  throughout  the  document  as  the  user   may  need  to  modify  methods  slightly  because  of  the  local  context  in  which  this  study  will  be  carried  out.

1.0  Scientific Background and Rationnale
The  novel  Coronavirus  now  known  as  Middle  East  Respiratory  Syndrome  Coronavirus  (MERS-­‐CoV)  was   first  detected  in  a  patient  living  in  Saudi  Arabia  in  September  of  2012.  Since  that  time,  sporadic  cases,     small  clusters,  and  in  large  outbreaks  have  been  reported  in  several  countries.  While  the  source  of  the   virus  is  currently  unknown,  it  is  thought  to  originate  in  animals.  Human-­‐to-­‐human  transmission  has  also   been  documented  on  multiple  occasions.  Although  finding  the  putative  animal  reservoir  is  an  important   step  in  controlling  spread  of  the  virus,  a  more  immediate  need  is  to  understand  the  route  and  mode  of   transmission  to  humans,  and  the  types  of  exposures  that  result  in  infection.  Several  possibilities  exist,   including  direct  contact  with  an  infected  animal,  which  could  be  either  the  reservoir  species  or  an   intermediate  host  species;  contact  with  or  consumption  of  unprocessed  animal  products;  contact  with   the  environment  where  an  infected  animal  has  recently  been;  or  consumption  of  a  food  or  beverage   which  has  been  contaminated  by  animal  excreta.  All  of  these  have  been  implicated  in  other  zoonotic   infections.  Learning  the  mode  of  transmission  to  humans  will  allow  measures  to  be  taken  to  interrupt   transmission.      This  investigation  will  provide  data  to  evaluate  risk  factors  for  infection  by  reviewing   exposures  of  known  cases  and  comparing  them  to  rates  of  exposure  in  similar  uninfected  individuals  in   the  general  population.  
Current  information  on  the  MERS-­‐CoV  and  cases  can  be  found  on  the  WHO   website:    
A  separate  protocol  is  available  specifically  for  assessment  of  exposed  Health  Care  Personnel  and   contacts  of  cases  (see­‐coronavirus-­‐MERS-­‐CoV/).     

1.1 Objectives
The  data  collected  from  this  study  will  be  used  to  refine/update  recommendations  for  surveillance  and   case  definitions,  to  characterize  the  key  epidemiological  transmission  features  of  MERS-­‐CoV  virus,  help   understand  spread,  severity,  spectrum  of  disease,  impact  on  the  community  and  to  inform  operational   models  for  implementation  of  countermeasures  such  as  case  isolation,  contact  tracing  and  quarantine.
The  primary  objective  of  this  study  is  to:   • Identify  modifiable  non-­‐human  exposures  that  lead  to  human  MERS-­‐CoV  infection

Complete Document:  

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