MERS-CoV found in camels
The International Health Regulations
Emergency Committee held their fourth
meeting to discuss the latest developments
with MERS-CoV on December 4.
The Committee concluded that it saw no
reason to change its previous advice to the
Director-General that the conditions for a
Public Health Emergency of International
Concern (PHEIC) have not at present
been met. However, the Committee stated
that situation continues to be of concern,
in view of ongoing cases and of new information
about the presence of the virus
in camels. The Committee plans to meet
again in March.
As of December 17, the WHO states it
has been informed of a total of 165 laboratory-
confirmed cases of infection with MERS-CoV, including 71 deaths.
CIDRAP, the Center for Infectious Disease
Research and Policy at the University of Minnesota reports (December 12 -
http://tinyurl.com/nhsb5t3) that reports that
dromedary camels in Jordan and Saudi
Arabia were found to have antibodies to
the virus or one closely related to it.
CIDRAP cites two studies published in
Eurosurveillance* in which Jordanian and European researchers reported that 11
11 camels tested in Jordan had MERSCoV-
like antibodies. The second study
found that 280 of 310 dromedary camels
from various parts of Saudi Arabia had antibodies
to MERS-CoV or a very similar
virus. In both studies tests in goats, sheep, and cows were negative. Earlier
researchers found MERS-CoV like antibodies
in camels in Oman, Egypt, and the
The research centre points out, however,
that “it remains unclear whether camels are
a source of MERS-CoV in humans, because
no one has yet demonstrated a close genetic
match between a camel MERS-CoV
isolate and a human isolate”, but adds that
“the new findings seem to strengthen the
evidence that many camels in the Middle East have been exposed to the pathogen”.
At the December 4 meeting the IHR
Emergency Committee emphasized he
- investigative studies, including international
case-control, serological, environmental,
and animal-human interface
studies, to better understand risk factors
and the epidemiology;
- further review and strengthening of
such tools as standardized case definitions
and surveillance and further emphasis on infection control and prevention.
* Reusken CB, Ababneh M, Raj VS, et
al. Middle East respiratory syndrome coronavirus
(MERS-CoV) serology in major
livestock species in an affected region in
Jordan, June to September 2013. Eurosurveill
2013 Dec 12;50 (18): pii=20662
Hemida MG, Perera RA, Wang P, et al.
Middle East respiratory syndrome (MERS)
coronavirus seroprevalence in domestic
livestock in Saudi Arabia, 2010 to 2013.
Eurosurveill 2013 Dec 12;50(18):pii=2065
The World Health Organisation answers
some frequently answered questions
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
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,
the United Arab Emirates, and the United
Kingdom. 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 laboratoryconfirmed
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
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
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.
What is the significance of the
recent finding of MERS-CoV in camels?
On 11 November, the Ministry of Health
of Saudi Arabia announced that MERSCoV
had been detected in a camel linked
to a human case in Saudi Arabia. This
finding is consistent with previously published
reports of MERS-CoV reactive
antibodies in camels, and adds another
important piece of information to our
understanding of MERS-CoV ecology.
However, this finding does not necessarily
implicate camels directly in the chain
of transmission to humans. The critical question that remains about this virus
the route by which humans are infected,
and the way in which they are exposed.
Most patients who have tested positive for
MERS-CoV had neither a human source
of infection nor direct exposure to animals,
including camels. It is still unclear
whether camels, even if infected with
MERS-CoV, play a role in transmission
to humans. Further genetic sequencing
and epidemiologic data are needed to understand
the role, if any, of camels in the
transmission of MERS CoV to humans.
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
How is the virus being
transmitted to humans?
We still do not know the answer to this question. It is unlikely that
the MERs-CoV to people occurs through
direct exposure to an infected camel, as
very few of the cases have reported a camel
exposure. More investigations are needed
to look at the recent exposures and activities
of infected humans. WHO is working
with partner agencies with expertise in
animal health and food safety, including
FAO, OIE and national authorities, to facilitate these investigations. Many
technical organizations are offering their expertise to assist ministries
responsible for human health, animal health, food, and agriculture.
Investigation protocols and guidelines for dealing with new cases are available
on the WHO website.
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.
Are health workers
at risk from MERS-CoV?
Yes. Transmission has occurred in healthcare
facilities, including spread from patients
to health-care providers. WHO
recommends that health-care workers
consistently apply appropriate infection
prevention and control measures.
MERS-CoV infections update (WHO)
of upload: 17th Jan 2014