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 of the new coronavirus which has killed more than 50% of the people who get it. This was one of several urgent actions needed at a national level to stem the growing outbreak of the disease, according more than 100 public health experts who met at WHO’s Eastern Mediterranean Regional Office (WHO EMRO) in Cairo in June. Middle East Health reports.

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 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.

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 chronic conditions.

The newly emergent virus is a part of the coronavirus family that includes the severe acute respiratory syndrome coronavirus (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 extensive 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 patterns.

In the first pattern, sporadic cases occur in communities. At present, we do not know the source or how these people became infected.

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 nationally.

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 testing, and 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.

 Date of upload: 18th Jul 2013


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