The MERS coronavirus does not appear to be spreading widely in Saudi Arabia, says an international team of experts who formed a Joint Mission of the World Health Organization and the Kingdom of Saudi Arabia that has just concluded a 6-day study.

The experts met in the Saudi capital, Riyadh, to determine what the situation is regarding MERS-CoV (Middle East respiratory syndrome coronavirus). They explained that MERS-CoV is a new emerging virus that is related to the SARS coronavirus (SARS CoV).

Update: June 17th, 2013Saudi health officials announced four more deaths from MERS-CoV infection, bringing the death toll in the country to 32 and 37 worldwide.

The first reported and confirmed case of MERS-CoV occurred in early 2012 in Jordan. So far, there have been 55 laboratory-confirmed cases of MERS-CoV human infection. Forty of them have occurred in Saudi Arabia. Apart from some infections in France, German, Italy and the UK, the rest have occurred in the Middle East and Tunisia.

Fifty five confirmed infections worldwide is a small number. However, MERS-CoV has a 60% death rate. The members of the Joint Mission explained that approximately three-quarters of all cases in Saudi Arabia have been in men, most of whom already had at least one major chronic medical condition.

There appear to be three main epidemiological patterns to MERS-CoV:

  1. Random, intermittent infections – initially, sporadic cases appear in communities. Nobody yet knows what the source of MERS-CoV is, or how people became infected
  2. Family clusters start to occur, where person-to-person transmission appears to have taken place. However, this human transmission is limited to people who are in very close contact with the infected person.
  3. Hospital acquired infections – in the third pattern, clusters in health care facilities emerge. Such clusters have been reported in Saudi Arabia, France and Jordan.

The experts said that two major points need to be emphasized:

  • There is no evidence of widespread human-to-human MERS-CoV transmission. Where person-to-person transmission is suspected, this has occurred with very close contact between family members, a health worker, and an infected patient.
  • MERS-CoV does not cause as many infections in health care workers compared to what occurred during the SARS epidemic ten years ago, according to data examined in Saudi Arabia.

    Infection risk among health care workers was a big problem during the SARS epidemic. The MERS-CoV is different. However, nobody knows yet why fewer health care personnel become infected with MERS-CoV. Perhaps infection control measures have improved over the last ten years. The Mission members say that the Saudi infection control measures have been effective.

No bedside tests exist for MERS-CoV. Diagnosis relies on doctors and health care professional being aware of the signs and symptoms, combined with confirmatory laboratory testing of the MERS-CoV by the polymerase chain reaction.

There is no targeted treatment for MERS-CoV infection. Current treatment is primarily supportive. WHO says that there is no compelling evidence showing that using antiviral medications, such as interferon and ribavirin brings any benefit. Doctors should not administer steroids to infected patients.

After being in Saudi Arabia from June 4th to 9th, gathering and analyzing data and visiting facilities, the Joint Mission concluded that the country “has done an excellent job in investigating and controlling the outbreaks”.

As soon as the first case was confirmed and identified last year, several steps were taken, including:

  • Hospital outbreaks – several measures were introduced, including infection control measures
  • Surveillance – of MERS-CoV cases was increased considerably
  • Awareness – campaigns were launched to educate and alert members of the public
  • Reporting – all MERS-CoV confirmed infections were reported to WHO
  • Epidemiological – studies were ordered to try to find the sources of infection, MERS-CoV risk factors and routes of transmission
  • International Cooperation – the Kingdom of Saudi Arabia invited a team of experts from around the world to help

The Mission team believes that Saudi health authorities have applied appropriate prevention and control measures. “The Government of Saudi Arabia is to be congratulated for urgently taking crucial actions,” they added.

There is still a great deal we do not know about MERS-CoV, they warned. Although much work has already been carried out, such investigations take some time before producing results.

Governments, health authorities, health professionals and relevant organizations are growingly concerned about this coronavirus’ potential for becoming a serious pandemic. With millions of people travelling by plane each day, the possibility that it might suddenly spread worldwide is a serious one.

It is vital that health care workers throughout the world become aware of MERS-CoV and how it can infect humans. Unexplained cases of pneumonia need to be checked immediately for MERS-CoV. Any confirmed cases of MERS-CoV infection should be reported to WHO immediately, under the terms of the 2005 International Health Regulations.

CDC (Centers for Disease Control and Prevention) scientists are still waiting to test samples of MERS-CoV that infected a Qatari patient and killed a Saudi man last year. Bureaucratic delays in obtaining samples and analyzing them in centers of excellence around the world are making it extremely hard to gain more knowledge on this virus, so that we can find out its source and how it infects humans.

Written by Christian Nordqvist