World’s health experts meet in Cairo to stem outbreak of deadly Middle East Respiratory Syndrome Coronavirus
Countries need to strengthen their abilities to control, detect, and treat cases
new coronavirus which has killed more than 50% of the people who get it. This
of several urgent actions needed at a national level to stem the growing
the disease, according more than 100 public health experts who met at WHO’s
Mediterranean Regional Office (WHO EMRO) in Cairo in June. Middle East Health
The novel coronavirus was recently
named the Middle East Respiratory Syndrome
Coronavirus (MERS-CoV). Globally,
from September 2012 to Middle East
Health press date (24 June), WHO has
been informed of a total of 77 laboratoryconfirmed
cases of infection with MERSCoV,
including 40 deaths.
CIDRAP News reports that six of the
nine cases reported in Saudi Arabia in late
June were asymptomatic, suggesting the
possibility that people can unknowingly
carry and spread the virus.
As of 24 June, WHO has received reports
of laboratory-confirmed cases originating
in the following countries in the
Middle East: Jordan, Qatar, Kingdom of
Saudi Arabia (KSA), and the United Arab
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
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.
Most of the cases have occurred in KSA
and so far, about 75% of the cases in that
country have been in men and most have
occurred in people with one or more major
The newly emergent virus is a part of
the coronavirus family that includes the severe acute respiratory syndrome
(SARS - CoV), first recognised as a
global threat in March 2003 and by July
2003, had resulted in 8,098 SARS cases
in 26 countries, with 774 deaths.
According to a WHO Global Alert report,
June 20, the newest cases indicate that the
source of infection, which has still not been
determined, remains active in the Middle
East and is present throughout a large area,
including new regions in Saudi Arabia.
Although the exact timing and nature of
exposures that result in infection is usually
unknown, evidence in cases exposed over a
range of time suggests that, at least in a minority
of cases, the incubation period may
exceed one week but is less than two weeks.
At a meeting in Riyadh earlier in June the
WHO noted that large gaps in our knowledge about this virus remain. Although
work has been done and is ongoing, it should
be remembered that it often takes time for scientific
investigations to produce results.
Secondly, international concern about
these infections is high, because it is possible
for this virus to move around the world.
There have been now several examples
where the virus has moved from one country
to another through travellers.
Consequently, all countries in the world
need to ensure that their health care workers
are aware of the virus and the disease it
can cause and that when unexplained cases
of pneumonia are identified, MERS CoV
should be considered. If cases of MERS
CoV are found, they should be reported to
WHO under the terms of the International
Health Regulations (2005).
There appears to be three main epidemiological
In the first pattern, sporadic cases occur
in communities. At present, we do not
know the source or how these people became
In the second pattern, clusters of infections
occur in families. In most of these
clusters, there appears to be person-toperson
transmission, but it seems that this
transmission is limited to people who are
in close contact with a sick family member.
The third pattern comprises clusters of
infections in health care facilities. Such
events have been reported in France, Jordan
and KSA. In these clusters, the sequence
seems to be that an infected person
is admitted to hospital where that person
then transmits the virus to other people in
the health care facility.
In a statement WHO said two important
points need to be stressed.
First, there is no evidence of widespread
person-to-person transmission of MERSCoV.
Where it has been suspected that
the virus has been transmitted from person
to person, it appears that there had been
close contact between somebody who was
sick and another person: a family member,
a fellow patient or a health care worker.
Secondly, many fewer infections with MERS-CoV have been reported in healthcare
workers in KSA than might have been
expected on the basis of the previous experience
of SARS. During the SARS epidemic,
healthcare workers were at high risk of infection.
The MERS-CoV is different from
the SARS virus. Although the reason why
fewer healthcare workers have been infected with MERS-CoV is not clear, it could
be that improvements in infection control
that were made after the outbreak of SARS
have made a significant difference. In this
context, infection control measures in KSA
appear to be effective.
WHO EMRO meeting
At the WHO EMRO meeting in Cairo,
the experts – who came from all countries
affected by the virus in the Middle East
and North Africa and Europe – agreed
that there is a list of priority actions which
need to be agreed internationally and implemented
At an international level, fast and complete
reporting of cases, with contact histories, clinical
care and treatment outcomes in as much
detail as possible, and collected in a uniform
manner across countries, is necessary for the
international public health community to be
able to build up a picture of what works and
what doesn’t in combatting this virus.
“Having the same tools and protocols
in all countries allows us to draw on and
implement best practice from around the
world, and to pool our information and resources
most effectively on an international
level,” said Dr Ala Alwan, WHO Regional
Director for the EMR, who chaired
the meeting. “This meeting has taken us
an important step in that direction.”
“At the moment we have an important
window where cases have still been
relatively few and human transmission
is relatively limited,” added Dr Keiji Fukuda,
WHO Assistant Director-General
for Health Security and the Environment.
“We need to exploit this chance to agree
and implement the best public health
measures possible across the board for, in
so doing, we stand the best chance of controlling
this virus before it spreads further.”
In the area of mass gatherings, the participants
agreed that Member States should
to develop specific plans when MERS-CoV
might be an additional risk for an event,
and they also highlighted the need for standardised protocols for serological
systematic and sequential sample collection.
In the area of communications, the
value of fast and transparent reporting of
cases both to the public and to WHO via
the system of International Health Regulations
National Focal Points was highlighted,
while the needs to better understand
the probability and means of hospitalbased
transmission of the disease, and to
ensure hospitals had adequate knowledge
and facilities to treat cases, including the
most severe ones, were also highlighted.
“Collecting and sharing epidemiological,
clinical, immunologic, and genetic information
related to MERS-CoV infections in the
right way is essential if the disease is to be
better characterized in terms of source, exposure
and presentation. Coordinated and intersectoral
global action to increase regional
and inter-regional collaboration between
countries, WHO and other international
partners is vital,” the meeting concluded.
WHO requested all Member States to
promptly assess and notify WHO of any
new case of infection with MERS-CoV,
along with information about potential
exposures that may have resulted in infection
and a description of the clinical course.
Investigation into the source of exposure
should promptly be initiated to identify the
mode of exposure, so that further transmission
of the virus can be prevented.
At the time of going to press (June 22)
WHO did not advise special screening at
points of entry with regard to this event
nor does it currently recommend the application
of any travel or trade restrictions.
Meanwhile, Novavax Inc, a biopharmaceutical
company, reported 6 June that is had
successfully produced a vaccine candidate
designed to provide protection against the
recently emerging MERS – CoV.
The company believes that its MERS-CoV
vaccine candidate may provide a path forward
for a vaccine for this emerging threat.
Evidence is also accumulating to suggest
that nasopharyngeal swabs are
less sensitive for detecting infection
with MERS-CoV than specimens
taken from the lower respiratory track.
WHO now strongly recommends the
collection of lower respiratory specimens
such as sputum, endotracheal
aspirate or bronchoalveolar lavage for
diagnostic polymerase chain reaction
(PCR) when possible. If initial testing
of a nasopharyngeal swab is negative
in a patient strongly suspected to have
MERS-CoV infection, patients should
be retested using a lower respiratory
specimen or a repeat upper respiratory
specimen with an additional oropharyngeal
specimen if lower respiratory
specimens are not possible.
of upload: 18th Jul 2013