Here There and Everywhere

Expat wanderer

MERS Virus Found to be Widespread

Thank you, John Mueller, for this fascinating article from Science NOW:

Middle Eastern Virus More Widespread Than Thought

28 February 2014 12:45 pm

 

Trail of infection. Scientists have found MERS virus in camels from Sudan and Ethiopia, suggesting the virus is more widespread than previously thought.Bernard Gagnon/Wikimedia CommonsTrail of infection. Scientists have found MERS virus in camels from Sudan and Ethiopia, suggesting the virus is more widespread than previously thought.

It’s called Middle East respiratory syndrome, or MERS, after the region where almost all the patients have been reported. But the name may turn out to be a misnomer. A new study has found the virus in camels from Sudan and Ethiopia, suggesting that Africa, too, harbors the pathogen. That means MERS may sicken more humans than previously thought—and perhaps be more likely to trigger a pandemic.

MERS has sickened 183 people and killed 80, most of them in Saudi Arabia. A couple of cases have occurred in countries outside the region, such as France and the United Kingdom, but those clusters all started with a patient who had traveled to the Middle East before falling ill.

Scientists have uncovered more and more evidence implicating camels in the spread of the disease. They found that a large percentage of camels in the Middle East have antibodies against MERS in their blood, while other animals, such as goats and sheep, do not. Researchers have also isolated MERS virus RNA from nose swabs of camels in Qatar, and earlier this week, they showed that the virus has circulated in Saudi Arabian camels for at least 2 decades.

Malik Peiris, an infectious disease researcher at the University of Hong Kong, and colleagues expanded the search to Africa. In a paper published last year, they showed that camels in Egypt carried antibodies against MERS. For the new study, they took samples from four abattoirs around Egypt; again they found antibodies against MERS in the blood of 48 out of 52 camels they tested. But the most interesting results came from taking nose swabs from 110 camels: They found MERS RNA in four animals that had been shipped in from Sudan and Ethiopia.

Peiris cautions that it is unclear whether the infected camels picked up the virus in Sudan and Ethiopia or on their final journey in Egypt. Abattoirs could help spread MERS just like live poultry markets do for influenza, he says. “You cannot point the finger exactly at where those viruses came from,” he says. “But I would be very surprised if you do not find the virus in large parts of Africa.”

If so, that changes the picture of MERS considerably. No human MERS cases have been reported from Egypt or anywhere else in Africa, but if camels are infected, they may well occur, says Marion Koopmans, an infectious disease researcher at Erasmus MC in Rotterdam, the Netherlands. “It would be important to look systematically into that,” she writes in an e-mail. “Health authorities really need to test patients with severe pneumonia all across Africa for MERS,” Peiris says.

The researchers were able to sequence the virus of one of the camels almost completely, and it is more than 99% identical with viruses found in people. “I would be very surprised if this virus cannot infect humans,” says Christian Drosten, a virologist at the University of Bonn in Germany. But the virus also shows a few intriguing differences from known camel samples, he says. “We have to analyze this carefully in the next few days, but it looks like this sequence broadens the viral repertoire found in camels,” he says. If the viruses found in camels show more genetic variation than those isolated from humans, that is further strong evidence that camels are infecting humans and not the other way around.

Anthony Mounts, the point person for MERS at the World Health Organization in Geneva, Switzerland, says that it is very likely that human MERS cases occur in Africa. “Wherever we find [infected] camels, there is a good chance we’ll find [human] cases if we look closely,” he says. And humans may be exposed to camels in Africa much more often than in the Middle East: There were about 260,000 camels in Saudi Arabia in 2012, but almost a million in Ethiopia and 4.8 million in Sudan, according to the U.N. Food and Agriculture Organization. The more human cases there are, the higher the risk that the virus will one day learn how to become easily transmissible between people, which could set off a pandemic.

The researchers also looked at the blood of 179 people working at the camel abattoirs for antibodies against MERS virus, but found none. That shows that the virus is only rarely successful in infecting human beings, Peiris says. “What we need to find out now is the reason for these rare transmissions.”

March 1, 2014 Posted by | Africa, ExPat Life, Health Issues, Interconnected, Kuwait, Living Conditions, News, Qatar, Saudi Arabia, Sudan | , , , , | Leave a comment

Most MERS Cases Undetected, report shows

Interesting, Qatar announced today their fourth case – this article says they have had eight confirmed cases and one Tunisian who visited Qatar and came down with MERS. From the Gulf Times:

 

Most Mers cases going undetected, study says

Researchers estimate that for each case that has been found, five to 10 may have been missed

  • Gulf News Report
  • Published: 21:32 November 16, 2013

  • Image Credit: Reuters
  • The Mers coronavirus typically causes severe respiratory problems.

Dubai: A new analysis of Mers case data suggests a large number of infections are going undetected, with the researchers estimating that for each case that has been found, five to 10 may have been missed.

The scientific paper, from European researchers, further suggests that transmission of the Mers virus is occurring at a rate close to the threshold where it would be considered able to pass from person to person in a sustained manner. In fact, the authors say based on the available evidence they cannot rule out the possibility that person-to-person spread is the main mode of transmission of the virus at this point. The other option, they say, is that the virus is spreading via a combination of animal-to-person and then person-to-person transfer.

“We conclude that a slow growing epidemic is underway, but current epidemiological data do not allow us to determine whether transmission is self-sustaining in man,” they write in the article, published in the journal Lancet Infectious Diseases.

The scientists are from Imperial College London, the University of Edinburgh and the Institut Pasteur in Paris. The work was done with funding from Britain’s Medical Research Council, the Bill and Melinda Gates Foundation and other agencies.

To date there have been roughly 155 confirmed MERS cases and at least 65 of those infections have ended in death. All the cases trace back to infections in a handful of countries on the Arabian Peninsula: Jordan, Saudi Arabia, Qatar, the United Arab Emirates and Oman.

On Wednesday, Kuwait reported its second case Mers coronavirus for a man who just returned from abroad, the health ministry said.

In a statement cited by the official KUNA agency, the ministry said the new case was for a 52-year-old Kuwaiti national who was in a stable condition. Media reports said the patient had just returned from a visit to neighbouring Saudi Arabia.

The announcement came hours after Kuwait reported its first case of the Mers virus for a 47-year-old Kuwaiti man who was in critical condition.

Last weekend, Omani officials widened health checks following the country’s first death blamed on Mers. Officials looked for any sign of the virus in people who came in contact with a dead 68-year-old man.

Neil Ferguson, from Imperial College’s MRC Centre for Outbreak Analysis and Modelling, said that while publicly available data are spotty, calculations based on what is known support the argument that only a small proportion of cases are coming to light.

“At the very least there probably have been double that number of infections,” Ferguson said in an interview.

“But it’s considerably more likely in my view that we’ve had maybe five to 10 times more human infections than that. And symptomatic human infections, I would say.”

He stressed that he and his co-authors are not suggesting that the Mers-affected countries are hiding cases, just that the way they are looking for them is not capturing the full scope of the outbreak.

Experts have previously expressed concern that surveillance systems that look only for Mers among people who seek hospital care will only catch the sickest of cases. And in at least one affected country, Saudi Arabia, the criteria for who gets tested for Mers may be less inclusive still.

Dr. Anthony Mounts, the World Health Organisation’s leading expert on Mers, said the agency has been told Saudi health officials are focusing their testing on people with Mers-like symptoms who are gravely ill.

“I know that their surveillance strategy is focused on intensive care patients,” Mounts said in an interview. “That’s the focus of their surveillance strategy.”

Mounts agrees that many Mers cases are probably being missed. But he noted that some other affected countries are taking a different testing approach. For instance, Qatar has tested over 3,000 specimens over the past six months, looking for Mers in people who seek medical help for influenza-like illness, and all people diagnosed with pneumonia.

“They really are testing a lot of people and they’re not seeing this,” he said.

Eight Qataris have been diagnosed with MERS since the virus hit the global public health radar in September 2012. As well a man from Tunisia who contracted the virus is believed to have been infected on a visit to Qatar.

Because of the scarcity of publicly available data, Ferguson and his colleagues used some different approaches to try to estimate the state of the outbreak. He acknowledged that their calculations are estimates, and said of the analysis “it’s not definitive … but I still think it’s informative at least.”

“I would say we’re doing the best we can with the data available to try and address a couple of key questions,” he said. “We would certainly be in a better position if there was fuller [case] reporting.”

A commentary by Canadian epidemiologists lauded the team for the techniques they used to reach their conclusions. Dr. David Fisman and Ashleigh Tuite, who are with the University of Toronto’s Dalla Lana Faculty of Public Health, also hinted that the often-seen instinct to withhold information during infectious disease outbreaks may be futile in the era of computational biology.

“The ability to draw inferences about diseases from non-traditional data sources will hopefully both provide alternate means of characterising epidemics and diminish the temptation towards non-transparency in traditional public health authorities,” they wrote.

One of the questions Ferguson and his co-authors tried to answer relates to whether the virus is spreading person to person at this point or whether what is being seen are infections from an animal source that is igniting limited spread in people.

To do that, they tried to calculate what is known as the virus’s reproductive number — the number of people, on average, an infected person would pass the virus on to. For a virus to sustain itself in people, each person needs to infect at least one other person, a reproductive number of 1.0 or greater.

They could not come to a definitive conclusion, saying with what is known, either scenario is possible. But they said the evidence suggests the reproductive number is near 1.0.

— with inputs from agencies

November 24, 2013 Posted by | Cultural, Doha, ExPat Life, Health Issues, Interconnected, Kuwait, Living Conditions, Qatar, Saudi Arabia, Work Related Issues | , | Leave a comment