I have been following MERS-CoV since it first surfaced in September 2012. This past week there has been quite a bit of news about the outbreak and why we should all be paying attention. To underscore its importance, Friday the CDC released its weekly MMWR report solely focused on MERS-CoV and also a new set of updated Healthcare Guidelines.

Since it began, all eyes have been focused on Saudi Arabia, which appears to be ground zero for the MERS CoV outbreak (80% of the known cases).  However last week, the kingdom’s deputy minister of health, Dr. Ziad Memish, stated that he believes that the MERS CoV virus is infecting people around the world but the other countries aren’t looking!

In response to that comment, Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota told Helen Branswell, of The Canadian Press, “To suggest that cases of MERS-CoV infections are being missed all over the world carries no epidemiologic or virologic credibility among those of us who have spent our careers tracking down global emerging infections. Such a statement merely blames the rest of the world for the continued problems with transparency by the Kingdom of Saudi Arabia in responding to this public health crisis.”

He went on to say that if undiagnosed MERS cases were in hospitals in other parts of the world, health-care workers would be contracting the disease as they did SARS in 2003. (MERS is from the same virus family as the SARS coronavirus.) “They would become the sentinel canaries. We’re not seeing those.”

A bit of a global emerging infections catfight I would say!

This Is An Image From The Kingdom Of Saudi Arabia (Ksa) Ministry Of Health (Moh) Health Portal Website Showing A Country Map Noting The Locations Of Cases Within The Country.
This is an image from the Kingdom of Saudi Arabia (KSA) Ministry of Health (MOH) Health Portal website showing a country map noting case locations.

First, the facts as we know them as of June 7:

  • Globally, from September 2012 to date, WHO has been informed of total of 55 laboratory-confirmed cases of infection with MERS-CoV, including 31 deaths (representing a case fatality rate of 56.4 percent).
  • WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Italy, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred there for care of the disease or returned from the Middle East and subsequently became ill. In France, Italy, Tunisia and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.
    • The original source(s), route(s) of transmission to humans, and the mode(s) of human-to-human transmission have not been determined. (This is a bit unnerving!)
    • The median age of patients is 56 years (range: 2–94 years), with a male-to-female ratio of 2.6 to 1.0. All patients were aged >24 years, except for two children, one aged 2 years and one aged 14 years.
    • All patients had respiratory symptoms during their illness, with the majority experiencing severe acute respiratory disease requiring hospitalization. Information was not available for all cases; however, several patients had accompanying gastrointestinal symptoms, including abdominal pain and diarrhea, and many cases occurred among persons with chronic underlying medical conditions or immunosuppression, as reported to WHO.
    • WHO strongly encourages vigilance worldwide and testing when appropriate

1. CDC. Severe respiratory illness associated with a novel coronavirus- — Saudi Arabia and Qatar, 2012. MMWR 2012; 61: 820

2. Danielsson N, on behalf of the ECDC Internal Response Team,Catchpole M: Novel coronavirus associated with severe respiratory disease: case definition and public health measures. Euro Surveill2012; 17(39): pii=20282;

3. Zaki AM, van Boheemen S, Bestebroer TM, et al: Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814-20;

4. de Groot RJ, Baker SC, Baric RS, et al: Middle East respiratory syndrome coronavirus (MERS-CoV); announcement of the Coronavirus Study Group. J Virol 2013; May 15 [Epub ahead of print].

5. World Health Organization. Global Alert and Response (GAR): novel coronavirus infection — update (Middle East respiratory syndrome coronavirus). Geneva, Switzerland: World Health Organization; 2013.

6. European Centre for Disease Prevention and Control. Updated rapid risk assessment: severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV). Stockholm, Sweden: European Centre for Disease Prevention and Control; 2013.

7. European Centre for Disease Prevention and Control. Epidemiological update: additional confirmed cases of Middle East respiratory syndrome coronavirus (novel coronavirus) in France, Saudi Arabia, and Tunisia. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2013

8. World Health Organization. Global Alert and Response (GAR): novel coronavirus summary and literature update. Geneva, Switzerland: World Health Organization; 2013.