MERS-CoV and the host: a serious disease of those with disease

Case total currently stands at 150 including 64 deaths (PFC of 43%), with the World Health Organisation's latest update adding in the recent death (their tally says 149/63) and the Oman case and a new death being reported from eastern Saudi Arabia. The details for this latest patient are (FT#152):

• 56-year old male
• Comorbidities
• Contact of a previous case.

So, as the Oman case showed, transmission from a previous case can lead to mild illness. The Qatari case before that showed that a contact can be asymptomatic. This latest fatality highlights that under the right pre-existing disease conditions, even a 2nd "passage" of virus from a human to another human, can lead result in death. 

It's a very much about the health of the human host who acquires the virus, as we've seen all along with MERS and also among cases of influenza A(H7N9) virus infection.

The latest WHO update also notes that...

Patients diagnosed and reported to date have had respiratory disease as their primary illness. Diarrhoea is commonly reported among the patients and severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. It is possible that severely immunocompromised patients can present with atypical signs and symptoms.

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Nearly half the Indonesians performing Hajj may be over 60-years of age

On top of that, a quarter may have underlying illnesses. This, according to an article on Arab News, is an estimate based on comments from the Indonesian Ministry of Health and Religious Affairs, Haj Health Center.

As we know, age and underlying diseases, or "co-morbidities", are significant risk factors for more severe disease following MERS-CoV infection.

These data give an the world an insight into one visiting population, does it hold true for other countries as well? If so, we get a snapshot of why public health officials are concerned for the health of their country's Hajj pilgrims in the coming months. MERS-CoV transmission efficiency may be low, but the clicnial impact from this gathering may be high.

Globally mobile at-risk population + site of most infections + little knowledge of basic levels of virus source/community load at that site = less than ideal situation.

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