Saturday, July 20, 2013

Researchers explain most likely pathways of international spread of MERS coronavirus

July 20, 2013
Editing is mine - Excerpt:

The MERS coronavirus, which appears to have emerged in the Middle East in early 2012, has spread to several countries in Western Europe and North Africa where there have been localized clusters of cases. Worldwide about 80 cases have been confirmed, with a mortality rate of more than 50 per cent.

Dr. Khan said there is potential for the virus to spread faster and wider during two annual events that draw millions of domestic and foreign Muslims to Saudi Arabia. The first is umrah, a pilgrimage that can be performed at any time of year but is considered particularly auspicious during the month of Ramadan, which this year began on July 9 and ends on Aug. 7. The second is the hajj, a five-day pilgrimage required of all physically and financially able Muslims at least once in their life. It takes place Oct. 13-18 this year and is expected to draw more than 3 million people.

Dr. Khan's team analyzed 2012 worldwide airline traffic and historic hajj data to predict population movements in and out of Saudi Arabia and the broader Middle East during these two mass gatherings to help countries assess their potential for MERS introduction via returning travelers and pilgrims. He also used World Bank economic and per capita health care expenditure data to help gauge individual countries' abilities to detect imported MERS in a timely manner and mount an effective public health response.

Results of the study were published in the online journal PLOS Currents: Outbreaks.

Dr. Khan, an infectious disease physician, is the founder of BioDiaspora, a web-based technology that uses global air traffic patterns to predict the international spread of infectious disease. The BioDiaspora platform has been used by numerous international agencies, including the U.S. Centers for Disease Control and Prevention, the European Centre for Disease Prevention and Control and the World Health Organization to evaluate emerging infectious disease threats, including those during global mass gatherings such as the Olympics and the hajj.

"With millions of foreign pilgrims set to congregate in Mecca and Medina between Ramadan and the hajj, pilgrims could acquire and subsequently return to their home countries with MERS, either through direct exposure to the as-of-yet unidentified source or through contact with domestic pilgrims who may be infected," he said.

Dr. Khan's team found that of the 16.8 million travelers who flew on commercial flights out of Saudi Arabia, Jordan, Qatar and the United Arab Emirates between June and November 2012 (the period starting one month before Ramadan and ending one month after the hajj) 51.6 per cent had destinations in just eight countries: India (16.3 per cent), Egypt (10.4 per cent), Pakistan (7.8 per cent), Britain (4.3 per cent), Kuwait (3.6 per cent), Bangladesh (3.1 per cent), Iran (3.1 per cent) and Bahrain (2.9 per cent).

Twelve cities--Cairo, Kuwait City, London, Bahrain, Beirut, Mumbai, Dhaka, Karachi, Manila, Kozhikode (India), Istanbul and Jakarta--each received more than 350,000 commercial air travelers between June and November 2012 from the four countries where MERS cases have been traced back to.

#H7N9 China: New Case in Hebei, Onset: 7/10 Adm: 7/13 Critical Condition Now

July 20, 2013

Hong Kong (HKSAR) - The Centre for Health Protection (CHP) of the Department of Health (DH) has been notified by the National Health and Family Planning Commission (NHFPC) an additional human case of avian influenza A(H7N9) in Hebei today (July 20) affecting a 61-year-old woman.

The patient developed cough andfever on July 10 and sought medical attention at a local hospital for further management on July 13. She was transferred to a hospital in Beijing on July 18 and she is currently in critical condition.

The patient's respiratory specimen tested positive for avian influenza A(H7N9) virus upon laboratory testing by the Beijing health authority.

To date, a total of 133 human cases of avian influenza A(H7N9) have been laboratory confirmed in the Mainland, including Zhejiang (46 cases), Shanghai (33 cases), Jiangsu (28 cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Shandong (two cases), Hunan (two cases), Beijing (two cases) and Hebei (one case).


Friday, July 19, 2013

#MERS #Coronavirus Saudi Arabia - 2 New Cases - in ICU

18 July 2013
Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that two confirmed cases of this virus have been recorded. The first case is for a 41-old-year Saudi male in Riyadh. The second case is for a 59-year-old Saudi female in Al-Ahsa governorate. Both cases are at the ICU receiving the proper treatment.
It is worth mentioning that, the MOH has tested 64 samples recently, given that, all of such samples have been proved negative, May Allah be praised, except the cases that have been published.​ 

Dr Keiji Fukuda quotes from virtual Press conference after Emer. Comm. decision - 4/17/13

July 19, 2013

A top World Health Organisation (WHO) official has asked people in the country and region to stay properly informed on the deadly Mers virus that has claimed over 40 lives and infected 84 others, mainly in Saudi Arabia.
During a virtual Press conference held from Geneva on Wednesday night, Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security and Environment spoke to Khaleej Times and gave a message for the people staying in the midst of where the virus is said to have originated and got its name the Middle East Respiratory Syndrome (Mers).
 “The most basic and important message for the people who are living in the community is that they should be aware that there is a virus, particularly if you are in a country where a number of cases
have been reported,” he said.
 “Especially if we are dealing with a new virus and we do not have the full information available,” he said. “Being informed is the foundation for taking care of yourself and your family. This is something we would recommend,” he added.
 The Press conference was held after WHO concluded an emergency committee meeting to assess the current threat posed by the virus. The committee stopped short of declaring a travel ban despite a looming threat as Saudi Arabia prepares for Haj pilgrimage.
 Dr Fukuda said that MERs, at the moment, did not meet conditions for a public health emergency of international concern.
 “We do not have specific information on how people are getting infected. However, we have a way for people to prevent themselves from getting infected or transmitting the infection,” he told Khaleej Times. “For example, it is important to wash your hands as hygiene turns out to be a very important way of preventing infection especially with soap and water or sanitisers. But one important thing to do is to keep your hands clean.”
 He further said: “Another thing is that if you are developing symptoms such as respiratory problems and they become severe such as high fever and have trouble breathing, it is really important to seek medical care and not wait too long.”
 “These are individual actions you can take that can reduce your chances of getting infected,” he added.
 The committee also said that WHO should help nations boost their surveillance system and laboratory capacity and also inform the public on reducing risks for infection.
 Saudi Arabia has discouraged the elderly, pregnant women and children from performing Hajj while WHO said it will release travel guidelines in a few days.
 Dr Fukuda said that such move was a national matter.
 Earlier this week, the UAE reported its first case of the MERS when an 82-year-old man was diagnosed with virus who is currently being treated in Abu Dhabi. Hospitals in the country have been asked to monitor patients and report immediately.
 The UAE health ministry said it was also monitoring the situation but no travel bans for Haj have been announced yet.
 The virus carries a 50 per cent rate of mortality in confirmed cases which is a major concern. Cough, fever and respiratory failure are primary symptoms. Secondary conditions associated with the virus include acute renal failure, multi-organ failure, acute respiratory distress syndrome (ARDS), and consumptive coagulopathy — a clotting disorder that leads to hemorrhage, organ failure and death.

Study: H7N9 highly transmissible by airborne route

[bolding is mine]
Lisa Schnirring | Staff Writer | CIDRAP News

Jul 18, 2013
Chinese researchers who did extensive work on H7N9 viruses from birds and humans found that one of the human strains was highly transmissible by aerosol droplets in ferrets, fueling more concerns that the new virus could spread between people.
The potential for aerosol spread is one of the key factors health officials use in gauging a new virus's pandemic potential, and the new study follows closely on the heels of two others that also found evidence of respiratory droplet transmission in ferrets.
The newest findings were reported today in an early online edition of Science by a team based at the Harbin Veterinary Research Institute, a World Health Organization (WHO) collaborating center.

Genetic comparisons produce new clues

Scientists ran multiple tests on H7N9 viruses obtained during poultry surveillance and isolated from human cases to get a clearer picture of its pathogenicity, virulence, replication, and transmissibility.
They sequenced the genomes of 37 representative H7N9 samples, most of which came from live-poultry markets, and compared them with five human isolates. The hemagglutinin (HA) and neuraminidase (NA) genes were highly similar, but they found more diversity in the six internal genes. They also found that the viruses are still capable of frequent reassortment and rapid evolution.
When they examined the basic polymerase 2 (PB2) gene for amino acids associated with flu virulence and transmission in mammals, they found that all of the bird and environment samples had the amino acid combination 627E/701D. The human isolates, in contrast, had either the 627K or 701N mutation, both of which are important for virulence and transmission.
The group wrote that the findings suggest the mutations may have occurred during replication in humans.
Experiments to explore receptor binding, another factor that plays a role in flu virus replication and transmission, identified a 1243V mutation that—similar to the Q226L mutation—may play a key role in exclusive binding to humanlike receptors for two of the avian isolates and two of the human samples.

Tests track aerosol transmission, other factors

Virulence and infection tests in birds confirmed that the H7N9 virus was low pathogenic in poultry and that infected chickens shed the virus for up to 7 days.The researchers said this finding suggests that chickens "may be one of the major carriers and spreaders of H7N9 viruses in the live poultry markets."
In tests on mice that were given lethal doses of H7N9, no signs of disease or death were seen in the ones that received viruses isolated from birds, but the animals infected with human isolates lost weight, got very sick, or died. Similarly, the group's replication tests on mice infected with human strains found higher viral titers in the nasal passages and lungs when compared with animals infected by the bird strains.
Replication experiments in ferrets also showed differences between the bird and human H7N9 strains. The group's pathology tests on ferret lung samples found severe bronchopneumonia and prominent viral antigen expression in the animals infected with three human strains and one of the bird strains. Ferret lungs, though, appeared normal after infection with a poultry H7N9 strain.
Aerosol transmission studies involved placing uninfected ferrets in cages adjacent to those housing infected ferrets. The investigators found H7N9 in one ferret exposed to those infected with one of the bird strains and two human strains isolated from some of the first patients in Shanghai. However, the virus was detected in all three ferrets exposed to animals infected with a human H7N9 strain isolated form a patient in Anhui province (AH/1).
To assess reproducibility, they repeated the aerosol transmission test with the AH/1 isolate and got the same result.
Senior author Hualan Chen, PhD, told CIDRAP News that there was no significant difference in transmission among four of the five viruses they tested in aerosol transmission testing. "The transmission of AH/1 to all three ferrets suggests that the H7N9 virus has great pandemic potential," she said.
The team noted that it's difficult to pinpoint which amino acid substitution alone makes the virus highly transmissible, but the amino acid differences between the avian viruses and the Anhui virus range from 1 to 27, suggests that only a few changes are needed to make the virus highly transmissible in mammals.
"Moreover, these changes can occur easily during replication in humans," they added.
Overall, the team said their tests found that the H7N9 viruses from poultry and humans can bind to human airway receptors and can replicate efficiently in ferrets, and that one human isolate can transmit efficiently among ferrets by aerosol droplets.
Chen said she was surprised that all of the viruses tested are able to bind to humanlike receptors and that the PB2 gene of the virus so easily gains mutations during replication in humans that boost its virulence and transmissibility.

Experts weigh pandemic potential

She said the group's findings are useful for weighing the threat from the virus. "This study suggests that the H7N9 virus is likely to transmit in humans, and immediate action, not only in China, is needed to prevent a possible pandemic caused by such a virus," Chen said.
The ability of the virus to transmit easily in poultry across a large part of China over a brief period points to the importance of control measures in poultry markets, the group said. But stamping out H7N9 will be a big, long-term challenge, because the virus spreads silently in chickens and also spreads to humans.
Ian Mackay, PhD, a virologist at the Australian Infectious Diseases Research Centre at the University of Queensland, told CIDRAP News that the study's molecular epidemiology component is the largest of its kind to date and adds many more complete H7N9 genomes to the publicly accessible GenBank database.  Mackay also authors the Virology Down Under Web site.
He noted that the group's comparison between the human and avian strains found that they differed by less than 4% at the nucleotide level, "Sometimes there are no differences," he said, noting that the most divergent strains came from the Shanghai region, where 20% of the samples originated.
The team's infection experiments on chickens confirm that H7N9 is a silent spreader and that the birds shed the virus for about a week before their illness resolves, Mackay said.
Findings revealed that major differences between H7N9 viruses are at the amino acid level, with the most divergent segment at the PB1 gene. "But it is the PB2 and HA segment that harbors mutations of particular interest to document the journey from infrequent spillover events to sustained human-to-human pandemic-level transmission," he said.
Mackay added: "We know that pandemic potential does not rest solely on one or other amino acid change, but rather a collection of changes. We also don't know what we don't know yet."
The Harbin group showed the potential of H7N9 viruses to bind to both avian and human receptors and that human isolates replicated well in the upper airways, a site for efficient transmission, he noted.
"The study reinforces that even 'lowly' or inefficient transmission—only 33% of ferrets, for example—is still transmission," Mackay said. "That proportion would lead to a lot of human cases in densely populated or frequented areas."
Those factors might help explain the wide clinical spectrum that has been seen, as well as difficulties in tracking the source and the proportion of patients who get severely ill and die, he said.
Zhang Q, Shi J, Deng G, et al. H7N9 influenza viruses are transmissible in ferrets by respiratory droplet. Science 2013 Jun 18 [Abstract]

#MERS #Coronavirus UAE - 2 HCW's w/mild upper respiratory sym's not hospitalized

By AFP | AFP – 16 hours ago

In Saudi Arabia, one 42-year-old female health care worker and a 26-year-old man who were in close contact with a MERS patient are both suffering from mild symptoms and have not been hospitalised, WHO said. 

#MERS #Coronavirus United Arab Emirates Case List

This is my case list for the UAE.  The first case dates back to March, 2013.

Date Report:  3/26/13 – 17 Total Confirmed, 11 Deaths
Name:  73yo
From:  United Arab Emirates
Onset:  3/14
Adm:  3/19  Munich Klinikum Schwabing Hospital Flown from UAE
in private Jet,  on day 11 of illness
Confirmation:  3/23/13
DOD:  3/25/13
Note:  Died on day 18 of illness. 50 people being monitored medically.  Unchanged.
The full virus genome was combined with four other available full genome sequences in a maximum likelihood phylogeny, correlating branch lengths with dates of isolation. The time of the common ancestor was halfway through 2011. Addition of novel genome data from an unlinked case treated 6 months previously in Essen, Germany, showed a clustering of viruses derived from Qatar and the United Arab Emirates.

Date of Report  7/12/13 – Blue Font Represents contact cluster
Name:  82(M) – Index Case
From:  United Arab Emirates
Adm:  Hospital in Abu Dhabi, ICU
Note:  Is hospitalized with multiple myeloma.  

Date of Report:  7/18/13
Name:  28(M)
From:  Abu Dhabi
Note:  Healthcare worker of confirmed 82(M) above.  No sym’s.  Identified thru surveillance of confirmed case (82M 7/12).  From one of two hospitals.
WHO Update:

Name:  30(F)
From:  Abu Dhabi
Note:  Healthcare worker of confirmed 82(M) above.  No sym’s.  Identified thru surveillance of confirmed case (82M 7/12).  From one of two hospitals.
WHO Update:

Name:  30(F)
From:  Abu Dhabi
Note:  Healthcare worker of confirmed 82(M) above.  Upper respiratory sym’s.  Identified thru surveillance of confirmed case (82M 7/12).  Worked at one of two hospitals.  Stable condition.
WHO Update:

Name:  40(F)
From:  Abu Dhabi
Note:  Healthcare worker of confirmed 82(M) above.  Syms: upper respir.  Stable condition.  Identified thru surveillance of confirmed case (82M 7/12).  From one of two hospitals.
WHO Update:


WHO Middle East respiratory syndrome coronavirus (MERS-CoV) - update 7/18/13

WHO has been informed of six additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Of these, two cases have been reported from Saudi Arabia and four from the United Arab Emirates (UAE).
Both the cases in Saudi Arabia have mild symptoms and are not hospitalized. They are from Asir region. The first case is a 26-year-old man who is a close contact with a previously laboratory-confirmed case and the second case is a 42-year-old woman who is a health care worker.
In the UAE, the four cases are health care workers from two hospitals in Abu Dhabi who took care of an earlier laboratory-confirmed patient. Of these, two cases, a 28-year-old man and 30-year-old woman, did not develop symptoms of illness. The other two cases, both women of 30 and 40 years old, had mild upper respiratory symptoms and are in stable condition.
Globally, from September 2012 to date, WHO has been informed of a total of 88 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.
Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhea, in patients who are immunocompromised.
Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.
All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
WHO has convened an Emergency Committee under the International Health Regulations (IHR) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met. 

#MERS #Coronavirus UAE: 4 New Cases - all are contact cases of previous confirmed

The Health Authority Abu Dhabi (Haad) has registered four new cases with coronavirus. The new registered cases are in stable conditions.
It said: "As a preventive measure, they have been isolated to prevent transmission to others."
Immediately after discovering the first case, Haad in coordination with the Ministry of Health (MoH), started investigating and examining people with direct contact with the first patient.
The Haad noted that a total of 136 individuals representing medical staff and family members of the patient were examined. As a result of the screening, four new cases with the virus were confirmed.
The Ministry of Health (MoH) stated that it is following all the latest updates regarding the new virus with the World Health Organisation (WHO). It confirmed that the virus is not a concern for public health at the moment as the detected cases globally continue to be very low.
It reiterated that the current situation does not require a travel ban to any country in the world, nor screenings at different ports, or restrictions on trade. The MoH praised the cooperation and coordination among all the health authorities in the country to follow up the health situation and safeguard public health.

Thursday, July 18, 2013

#MERS #Coronavirus Saudi Arabia Case List

The Asir cluster [the case numbering is this blogs numbers only]:

#35—66(M)—Asir Province—Critical but Stable cond.
#36—26(M)—Asir Province—no adm—contact of #35—mild case
#37—42(F)—Asir Province—no adm—healthcare worker-mild case

#MERS #Coronavirus Saudi Arabia: 2 New Cases

17 July 2013
Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that two confirmed cases of this virus have been recorded. The first case is for a 26-old-year Saudi male in Asir, who was in contact with one of the cases previously announced to be infected with the virus. The second case is for a 42-year-old female resident working at the health sector in Asir. Both cases have mild symptoms, so it was not recommended to be hospitalized.

It is worth mentioning that, the MOH has tested 1460 samples from the beginning of the previous month (Sha‘ban), given that, all of such samples have been proved negative, May Allah be praised, except the cases that have been published.

China: H7N9 patient gives birth to healthy baby

NANJING, July 18 (Xinhua) -- The world's first pregnant woman infected with H7N9 bird flu gave birth to a heathy girl on Wednesday afternoon in a hospital in Zhenjiang City, east China's Jiangsu Province.

The 25 year old surnamed Qiu was five months pregnant when she was diagnosed with H7N9 on April 8. She was admitted to the intensive care unit in Zhenjiang No. 1 People's Hospital. She came around on April 21 and recovered in May.

Qiu received a Cesarean section on Wednesday afternoon and gave birth to a baby girl weighing 3.3 kg, according to doctors with hospital. Gu Shaoqing, head of the paediatric department, said Qiu's expected date of childbirth had been set for July 26. However, doctors monitored an acceleration in the fetal heart beat, and decided to carry out the operation on Wednesday.
They said Qiu's cardiopulmonary function still needs time for recovery. The hospital will continue to monitor the health of the mother and baby.

A total of 132 H7N9 avian flu cases have been reported on the Chinese mainland, including 43 that have ended in death, since the virus was first discovered in March, according to updates released by the National Health and Family Planning Commission on July 10. The spread of the disease has been brought under control, as there was only one new case reported in east China's Jiangsu Province last month and the patient has recovered, according to the commission's updates. 

Wednesday, July 17, 2013

#MERS Virus Not Yet a Global Emergency, WHO Panel Says

hat-tip Helen Branswell
on 17 July 2013

A special panel established by the World Health Organization (WHO) decided today that the novel coronavirus that has been infecting people in the Middle East is "very concerning," but does not yet constitute a "public health emergency of international concern."


Under a global agreement known as the International Health Regulations, the panel's declaration of an emergency would give WHO the power to issue recommendations on addressing MERS.
After convening by telephone for 4 hours this afternoon, the panel unanimously decided that the conditions for a public health emergency of international concern had not been met—so far.

The committee decided that "this was not the time to go ahead with such a declaration but to monitor the situation very closely," said Keiji Fukuda, WHO's assistant director-general for health security and environment, at a press conference in Geneva, Switzerland. In part, the decision reflected the negative effects an emergency declaration could also have, he noted. "You want to make these declarations when they are proportionate to the event."

The panel made the right call, says Mike Osterholm, director at the Center for Infectious Disease Research and Policy at the University of Minnesota, Twin Cities. But he worries that some people could take the decision to mean that there is nothing to worry about. "We have this unfortunate nomenclature that has been given to us," he tells ScienceInsider. "And it is either a yes or a no." 


ProMED Comments on WHO Emergency Committee assessment

WHO Statement (excerpt):

Based on these views and the currently available information, the Director-General accepted the Committee's assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute a PHEIC at this time.
excerpt: (comments after WHO statement)
[The above is the official statement of the WHO IHR Emergency Committee that was convened to assess the global risks of MERS-CoV. At present, the Committee felt that "with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met." The term Public Health Emergency of International Concern (PHEIC) is defined in the IHR (2005) as "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response." This definition implies a situation that: is serious, sudden, unusual or unexpected; carries implications for public health beyond the affected State's national border; and may require immediate international action. (see for a description of PHEIC procedures).

For the HealthMap/ProMED map of the Middle East Region where all cases to date have a direct or indirect link, see - Mod.MPP]

Frequently Asked Questions on Middle East Respiratory Syndrome – coronavirus (MERS-CoV)

[This will be updated on the right side-bar of this blog under MERS-CoV]
July 17, 2013

What is coronavirus?

Coronaviruses are a large family of viruses that cause illness in humans and animals. In people, coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory Syndrome (SARS).
The novel coronavirus, first detected in April 2012, is a new virus that has not been seen in humans before. In most cases, it has caused severe disease. Death has occurred in about half of cases.
This new coronavirus is now known as Middle East Respiratory Syndrome – coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013.

Where are MERS-CoV infections occurring?

Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia and the United Arab Emirates. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases.

How widespread is MERS-CoV?

How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.

What are the symptoms of MERS-CoV?

Common symptoms are acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms, including diarrhoea. Some patients have had kidney failure. About half of people infected with MERS-CoV have died. In people with immune deficiencies, the disease may have an atypical presentation. It is important to note that the current understanding of illness caused by this infection is based on a limited number of cases and may change as we learn more about the virus.

How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between co-workers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.

Is there a vaccine or treatment for MERS-CoV?

No. No vaccine is currently available. Treatment is largely supportive and should be based on the patient’s clinical condition.

How can people protect themselves from getting MERS-CoV?

It is not possible to give specific advice on prevention, as neither the source of the virus nor the mode of transmission is yet certain. It is always prudent to avoid close contact, when possible, with anyone who shows symptoms of respiratory illness and to maintain good hand hygiene. Other effective general measures include avoiding eating uncooked or undercooked meats, unwashed or unpeeled fruits or vegetables, and consuming drinks made without clean water. If you become sick while travelling, you should avoid close contact with other people while you have symptoms and use good respiratory hygiene. If you have respiratory symptoms, such as coughing or sneezing, you should cough or sneeze into a sleeve or flexed elbow, or tissue, and throw used tissues into a closed bin immediately after use.
The chances of contracting the virus are small. However, people who meet the following criteria should see a health-care worker as soon as possible: people who have travelled to the Middle East who develop breathing difficulties that are not explained by any other illness or virus; ill people who are immunocompromised and have recently travelled to the Middle East.

How many people have been infected by MERS-CoV?

Are health workers at risk from MERS-CoV?

Yes. Transmission has occurred in health-care facilities, including spread from patients to health-care providers. WHO recommends that health-care workers consistently apply appropriate infection prevention and control measures.

How is WHO responding to the emergence of MERS-CoV?

Since the emergence of this virus, WHO has been working under the International Health Regulations to gather scientific evidence to better understand this virus and provide information to Member States. For this purpose, WHO convened the first international meeting on MERS-CoV in Cairo in January 2013.
On 19-22 June, WHO convened a second meeting in Cairo to discuss advances in scientific research and the international response to MERS-CoV. On 5 July, WHO announced it would convene an Emergency Committee under the International Health Regulations (2005). This Committee will advise the Director-General as to whether this event constitutes a Public Health Emergency of International Concern (PHEIC). The Committee may also offer advice to the Director-General on public health measures that should be taken.
WHO is also working with affected countries and international partners to coordinate the global health response, including the provision of updated information on the situation, guidance to health authorities and technical health agencies on interim surveillance recommendations, laboratory testing of cases, infection control, and clinical management.

What is WHO recommending that countries do?

WHO encourages all Member States to enhance their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia cases. WHO urges Member States to notify or verify to WHO any probable or confirmed case of infection with MERS-CoV.

Has WHO recommended any travel or trade restrictions related to this new virus?

No. WHO does not recommend any travel or trade restrictions with respect to MERS-CoV. WHO will continue to review all recommendations as more information becomes available. 

WHO Statement on the Second Meeting of the IHR Emergency Committee concerning MERS-CoV

WHO Statement
17 July 2013
The second meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] was held by teleconference on Wednesday, 17 July 2013, from 12:00 to 16:04 Geneva time (CET).
In addition to Members of the Emergency Committee, an expert advisor to the Committee1 participated in the meeting. During the informational session of the meeting, several affected States Parties were also on the teleconference. The States Parties on the teleconference were: France, Germany, Italy, Jordan, Kingdom of Saudi Arabia, Qatar, Tunisia, and the United Kingdom.
The Committee reviewed and deliberated on information on a range of aspects of MERS-CoV, which was prepared or coordinated by the Secretariat and States in response to questions presented by Members during the first meeting.
It is the unanimous decision of the Committee that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.
While not considering the events currently to constitute a PHEIC, Members of the Committee did offer technical advice for consideration by WHO and Member States on a broad range of issues, including the following:
  • Improvements in surveillance, lab capacity, contact tracing and serological investigation
  • Infection prevention and control and clinical management
  • Travel-related guidance
  • Risk communications
  • Research studies (epidemiological, clinical and animal)
  • Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV to WHO in accordance with the IHR (2005).
The WHO Secretariat will provide regular updates to the Members and will reconvene the Committee, in September, on a date to be determined. However, serious new developments may require an urgent re-convening of the Committee before then.
Based on these views and the currently available information, the Director-General accepted the Committee’s assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute a PHEIC at this time.
The Director-General expressed her gratitude to the Committee on its wide range of advice on health actions for countries to implement, and advice on follow-up work by WHO.

1 Please note that the listing of Emergency Committee Members on the WHO website has been updated to include the adviser to the Committee.

For more information contact

Fadéla Chaib
Communications Officer
Department of Communications
WHO, Geneva
Telephone: +41 22 7913228
Mobile: +41 79 475 5556

Mr Tarik Jasarevic
Communications Officer
Department of Communications
WHO, Geneva
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14

Mr Glenn Thomas
Communications Officer
Department of Communications
WHO, Geneva
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677