MERS-CoV by the numbers: recent weekly case activity...

Click to enlarge.

Confirmed MERS-CoV cases (green) and

deaths (red) each week. Case numbers

are listed on the y-axis (side), days of each

week along the x-axis (bottom). Case dates

are derived from announced date of onset

but if absent, on the date of reporting.

This follows on from my previous post (you can follow its links to earlier weekly charts) about lab-confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) cases, plotted by week.

These charts are based on the reports that get into the public domain. Those of us trying to follow and deconvolute MERS-CoV case information pretty much all agree that the data are terrible, but they are what they are. For example, the data are currently absent details on 2 MERS-related deaths for which no links to our case lists can be found. There are 85 cases missing date of disease onset data (which makes these charts imperfect), 8 without an age, 10 without a sex and most have no date of hospitalisation or date of lab confirmation. As I've bemoaned before, a standardised numbering of cases would be helpful too. Among other things.

The charts suggest there is not a lot of activity in terms of new cases, and the number of deaths, thankfully, remain much lower than during the weeks preceding my post in early September.

You can see that during the Hajj (13th-18th of October), there were 3 cases and a death described but in the weeks immediately afterwards, there has been no spike in cases of MERS. What makes this a significant development is that, for the second time since we learned of MERS-CoV, countries outside the Kingdom of Saudi Arabia (KSA) have had a direct hand in the observation and testing of pilgrims. This adds some confidence that severe symptomatic MERS is a relatively rare disease and one that does not spread quickly and efficiently. We have no real data to say that virus doesn't spread quick, widely and efficiently however, just that the severe infection outcomes don't.

So, no sign of a major jump in new cases. In this 4-week period there have been 13 cases which is up 2 from the 4-weeks before that. There have been 3 deaths (PFC of 23.1%, well below the total average of 41.3%) in this period, down from 4 in the previous month.

These numbers still have to be considered with care. This week's Spanish case really shone a light on the issue of laboratory unconfirmed cases of clinically diagnosed pneumonia circulating in the KSA. And where there is one such case there are likely to be others. Many others? We don't know.

So with 155 cases and 64 deaths in 87-weeks, MERS seems to be ticking along, but it shows no signs of becoming a widespread health issue. While it has a PFC of 41%, that is a meaningless number until we start testing more widely than is being done now. There are still many questions to answer about its host, how humans acquire it, whether its widespread in the community - but on the topic of transmission, MERS does not look likely to become a pandemic any time soon.

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MERS-CoV update...

Click to enlarge. Schematic of the MERS-CoV.
Feel free to use, please just cite 
Virology Down Under and Dr Ian M Mackay

No major jump in Middle East respiratory syndrome coronavirus (MERS-CoV) cases over the past 2 weeks. Great to see.

In parallel to this slow-down in new announcements, the World Health Organization's last few MERS Disease Outbreak News (DONs; 19th Sept, 20th Sept and 4th Oct) announcements have have given no specific detail but rather age ranges, date of onset ranges and comments in a general and format that is not linked to specific cases.

While the 3rd Emergency Committee convened by the Director-General under the International Health Regulations decreed September 25th that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met, it did conclude the following:

• strengthening surveillance, especially in countries with pilgrims participating in Umrah and the Hajj;
• continuing to increase awareness and effective risk communication concerning MERS-CoV, including with pilgrims;
• supporting countries that are particularly vulnerable, especially in Sub-Saharan Africa taking into account the regional challenges;
• increasing relevant diagnostic testing capacities;
• continuing with investigative work, including identifying the source of the virus and relevant exposures through case control studies and other research; and
• timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO.

The following press briefing by Dr Keiji Fukuda noted that:

• cases have been found in 9 countries
• no umrah visitors were infected
• more cases in men than women (~59% male)
• about a third of (so-called sporadic) cases occur in the community; acquired there via an unknown exposure.
• older, male, underlying conditions have most severe outcomes
• suspicion is that exposure is related to animals but how remains unknown
• another group is person-to-person (family and hospital settings) that lead to clusters but no translation to community case spreads
• we are seeing the emergence of a new virus, limited to the Middle East, but the full picture remains to be captured
• we are seeing more mild cases as surveillance picks up but the disease should not be considered mild
• overall levels of testing after umrah is variable and overall  testing in a number of countries at particular risk of infection is sub-optimal
• an ideal level of surveillance should be sustained, not bankrupt the country or exhaust resources but identify whether infections are coming into a country or if infection trends are changing. The level of detail depends on the country.
• WHO is, in general, providing all the information they have

My count seems to be 139 cases with 58 deaths among those giving a PFC of 41.7%. This included the reclassification of 2 "local" Italian cases as probable rather than laboratory confirmed. FluTrackers and I keep the continuous numbering system though, we just deduct 2 from the tally.

Click to enlarge. A map showing countries where cases have
been detected (orange) and those where local transmission
has occurred (red).

In context of global infectious diseases, that is not a large number of cases but it remains a high proportion of deaths. 

To tackle this high PFC, we really need to do something, on a research basis (so as not to bankrupt or over-tax already strained diagnostic services), that was not specifically listed above; test more well people prospectively. This will address how widespread the virus is among those who are not older, male and sick with comorbidities.

Seems like a job for local academic medical researchers - with some special government funding made available perhaps?

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H7N9 in Beijing

A new location for H7N9 - Beijing (population >20,000,000) has reported 1st case of H7N9. 

Testing results were turned around in only 1 day - great job!

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