MERS Update 21st May 2014

Major centers (MOH - 26 April ) 3 specialized medical centers in KSA Riyadh, Jeddah and the Eastern Region Jeddah : King Abdullah Medical Complex Equipped with the medical capabilities and modern equipment

Specialist council (MOH - 27 April ) 10 Infectious Disease experts appointed Dr. Prof. Tariq Ahmed Madani - Internal Medicine & Infectious Diseases from King Abdulaziz University; Professor Eltayeb Abuelzein - Virology & Veterinary Medicine from King Abdulaziz University; Dr. Esam Ibraheem Azhar - Molecular Virology from King Abdulaziz University; Dr. Anees Sendi - Pulmonary and Critical Care Medicine from King Abdulaziz University, Dr. Abdulhakeem Althaqafi - Internal Medicine & Infectious Diseases from King Faisal Specialist Hospital; Dr. Basem Alraddadi - Internal Medicine & Infectious Diseases from King Faisal Specialist Hospital; Dr. Mohammad Qutb - Laboratory Medicine from King Faisal Specialist Hospital; Dr. Ali Alshareef - Emergency Medicine & Intensive Care from National Guard Hospital ; Dr. Yaser Mandoora - Pulmonary, and Critical Care Medicine from Ministry of Defense; Dr. Samar Badruddin - Internal Medicine & Infectious Diseases from Fageeh Hospital. Dr. Samar Badruddin - Internal Medicine & Infectious Diseases from Fageeh Hospital.

Daily case count (MOH) http://www.moh.gov.sa/en/CoronaNew/PressReleases/Pages/default.aspx

Daily Case Reports (MOH)

Anonymised mortality data (MOH) An 80-year-old female was admitted to a government hospital in Jeddah. Her case was reported on May 11th, 2014. She passed away on May 11th, 2014. May Allah have mercy upon her. A 67-year-old male was admitted to a government hospital in Jeddah. His case was reported on April 23th, 2014. He passed away on May 16th, 2014. May Allah have mercy upon him. A 55-year-old male was admitted to a government hospital in Jeddah. His case was reported on May 1st, 2014. He passed away on May 16th, 2014. May Allah have mercy upon him. A 71-year-old male was admitted to a government hospital in Riyadh. His case was reported on May 14th, 2014. He passed away on May 16th, 2014. May Allah have mercy upon him. A 77-year-old male was admitted to a government hospital in Al-Madinah. His case was reported on May 7th, 2014. He passed away on May 16th, 2014. May Allah have mercy upon him.

Mashup - coronamap.com (Public)

Mashup - coronamap.com

Change in transmission? (WHO) Unlikely Few tertiary cases Nosocomial outbreaks in Health Care 2ry milder than 1ry Tropic virus for non-ciliated epithelia (20%) Increased PCR testing

Period of infectivity 04/14 Period of infectivity: patients can shed the virus after resolution of symptoms, but the duration of infectivity is unknown. Patients are not contagious during the incubation period. Viral shedding <> viral transmission Studies are few.

Asymptomatic cases Likely that 20% are asymptomatic Asymptomatic cases might not be contagious.

CDC ‘3rd US case’ (17 May 2014) 40 minute contact 1ry to 2ry Business meeting Case definition : PCR + (not Ab +) Did not get sick and not hospitalised

The Camel Connection Recent studies support the premise that camels serve as the primary source of the MERS‐CoV infecting humans and that other livestock are not involved. Middle East Respiratory Syndrome Coronavirus Infection in Dromedary Camels in Saudi Arabia (Feb 2014) http://mbio.asm.org/content/5/2/e00884-14

Camel Facts Index case had 4 pet camels Seropositive since 1992 75% of dromedary camels in KSA (No. 203) Seropositivity now : 5% - 90% (Taif) PCR positive high rate upto 2 yrs Viral Nucleic Acids+ : 35% (juvenile) 15% camels

Camels v Humans <1% divergence genome analysis 3 kb (full genome 20-32 kb) Most found in nasal swabs 3 / 203 found in rectal swabs Camel reservoir likely: may be outside KSA (imported from Australia / Sub Saharan Africa) MERS elsewhere: low detection / susceptibility

Chronic disease patients (WHO) Take precautions when visiting farms, barn areas or market environments where camels are present. x camel contact: Hand hygiene x raw camel milk x food contaminated with animal secretions (wash and cook well)

General public & animals (WHO) When visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

Thank you