Friday, November 22, 2013

Middle East respiratory syndrome coronavirus (MERS - CoV) summary and literature update – as of 22 November 2013

Since  April  2012,  157  laboratory-­‐confirmed  and  19  probable  cases  of  human  infection  with  Middle   East  respiratory  syndrome  coronavirus  (MERS-­‐CoV)  have  been  reported  to  WHO.    Three  new   countries—Spain,  Kuwait,  and  Oman—have  reported  patients  with  MERS-­‐CoV  since  the  last  update.   Infections  in  Kuwait  and  Oman  were  likely  acquired  locally,  while  the  two  probable  cases  reported   by  Spain  were  both  recent  travellers  to  the  Middle  East.  The  cases  in  Spain  have  not  yet  been   confirmed,  pending  finalization  of  the  laboratory  testing.  To  date,  affected  countries  in  the  Middle   East  include  Jordan,  Kingdom  of  Saudi  Arabia,  the  United  Arab  Emirates  (UAE),  Qatar,  Oman  and   Kuwait.  Europe  countries  reported  include:  France,  Germany,  the  United  Kingdom  (UK),  Italy  and   Spain,  and  in  North  Africa:  Tunisia  (Figure  1).
Eighteen  of  the  27  new  cases  reported  since  the  last  update  cases  were  sporadic,  that  is,  cases  that   were  reported  to  have  no  prior  contact  with  another  known  case  and  including  cases  that  were  the   first  case  within  a  cluster.    Seven  cases  reported  contact  with  previous  confirmed  cases  and  two  are   unclassified  due  to  lack  of  information.  
Of  note,  all  four  recently  confirmed  cases  from  Qatar  were  reported  to  have  farm  contact.  The  first   case  was  a  61-­‐year-­‐old  Qatar  national  without  history  of  travel  or  contact  with  confirmed  cases.  The   farms  include  a  variety  of  animals,  including  camels,  sheep  and  poultry.  The  second  case  is  a  23-­‐year-­‐ old  male  resident  who  worked  on  the  farm  owned  by  the  first  case.  He  displayed  very  mild   symptoms  and  was  discovered  as  part  of  contact  screening.  The  third  and  fourth  cases  are  a  48-­‐year-­‐ old  man  and  a  61-­‐year-­‐old  man,  respectively.  Both  had  no  history  of  contact  with  previously   laboratory-­‐confirmed  cases  but  a  preliminary  investigation  indicated  that  they  had  frequent   interactions  with  farm  animals.  A  comprehensive  investigation  into  animal  exposures  of  the  cases   has  been  launched  by  the  Supreme  Council  of  Health  of  Qatar.   
On  10  November  2013,  the  Ministry  of  Health  of  Saudi  Arabia  announced  the  detection  of  MERS-­‐CoV   in  a  specimen  taken  from  an  ill  camel  owned  by  a  laboratory-­‐confirmed  case  from  Jeddah.  This  case   had  direct  contact  with  the  ill  camel.  If  confirmed,  this  will  represent  the  first  detection  of  MERS-­‐CoV   in  camels.    
Of  the  176  laboratory-­‐confirmed  and  probable  reported  cases  to  date,  69  (39.2%)  have  died  and   65.3%  of  those  for  which  sex  is  known  were  male  (111/170).  The  median  age  of  the  cases  with   reported  age  is  51  years  (range  14  months  -­‐  94  years;  n=172).    Sporadic  cases  (n=62)  are  more  likely   to  be  male  (76%  vs.  58%)  and  above  the  age  of  50  years  old  (66%  vs.  39%)  compared  with  secondary   cases  (n=97).


No comments: