Updated Map Showing the General Locations of MERS-CoV Cases on the Arabian Peninsula (June 25, 2014)

Current map of the general geolocations of more than 700 local MERS-CoV infections on the Arabian Peninsula as of June 25, 2014. Location names are labeled in red. The area of the circle depicts the relative number of reported cases at that location. 

 

Map note: On June 3, the Saudi Arabia Ministry of Health announced more than 100 additional MERS cases that occurred between May 2013 and April 2014 (link).  No geographic information about these cases was provided by the Ministry of Health and they are not included on this map. Previous map, April 21, 2014 here.

The Pressing Need to Identify the Intermediate Hosts of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

In an ahead-of-print article in Virology Journal [1], Cui and associates report the results of a study of the molecular evolution of DPP4, a cell-surface receptor, across the mammalian phylogeny.  Their analyses showed that the dN/dS value on the bat lineage (0.96) was four times greater than the mammalian average leading to the conclusion that Middle East respiratory syndrome coronavirus (MERS-CoV) ultimately has a bat-origin.

From the article –

Our analysis therefore suggests that the evolutionary lineage leading to current MERS-CoV co-evolved with bat hosts for an extended time period, eventually jumping species boundaries to infect humans and perhaps through an intermediate host. As such, the emergence of MERS-CoV may parallel that of the related SARS-CoV. Although one bat species, Taphozous erforatus, in Saudi Arabia has been found to harbour a small RdRp (RNA-Dependent RNA Polymerase) fragment of MERS-CoV, a larger viral sampling of bats and other animals with close exposure to humans, including dromedary camels . . . are clearly needed to better understand the viral transmission route. . . .

While bats may ultimately be the host reservoir for this coronavirus, the distribution of human infections throughout the Arabian Peninsula, among individuals of both genders, and various ages and occupations, indicates that there is some other intermediate host infecting the index cases and other sporadic cases in the region. The sooner the intermediate host is identified, the more likely that these outbreaks of MERS-CoV can be contained.

[1] Adaptive evolution of bat dipeptidyl peptidase 4 (dpp4): implications for the origin and emergence of Middle East respiratory syndrome coronavirus

h/t bgw

MERS-CoV Clusters in Saudi Arabia

As previously noted, at least seven clusters of Middle East respiratory syndrome coronavirus (MERS-CoV) cases have occurred in the Kingdom of Saudi Arabia (KSA) [1]. An additional eighth cluster can be inferred from official reports for the city of Medina [2]. Besides Medina, 3 clusters have been reported from Riyadh, and one each from Al Hofuf, Mecca, Asir Province (Bisha?), and Hafar Al-Batin. 

Besides these clusters, in July, the World Health Organization (WHO) reported laboratory confirmation of a female healthcare worker from Hafar Al-Batin  who had contact with a previously confirmed case [3]. The only prior confirmed case from Hafar Al-Batin  was a 16-year-old male who was reported to have died in June [4]. This would constitute another cluster from Hafar Al-Batin.

Since August 1, the KSA  Ministry of Health has reported at least seven individuals from Riyadh who were in contact with previously confirmed cases. Because of the lack of case details it is not possible to ascertain how many clusters of MERS-CoV cases may have occurred since then in Riyadh or are occurring there at this time.

The table below presents information on the location and potential number of cases associated with MERS-CoV clusters in the KSA using cluster numbers assigned by the CDC [5]. The maps shows the general areas where these clusters occurred.

Location of MERS-CoV Clusters in Saudi Arabia

[1] MERS-CoV is a Threat to Healthcare Workers and Hospital Patients

[2] A MERS-CoV Cluster Outbreak in Medina, Saudi Arabia 

[3] Middle East respiratory syndrome coronavirus (MERS-CoV) - update 

[4] MOH: Two New Confirmed Cases of Coronavirus Recorded in Al-Ahsa and the Eastern Region and One Case Passed Away in Hafr Al-Batin 

[5] Middle East Respiratory Syndrome (MERS): Clusters under Investigation

A MERS-CoV Cluster Outbreak in Medina, Saudi Arabia

Since August 28, seven cases of Middle East respiratory syndrome coronavirus (MERS-Cov) infection have been reported from the city of Madinah (Medina) by the Kingdom of Saudi Arabia Ministry of Health. Only minimal information about these cases has been provided in media statements.  The table below presents the information on these seven cases. Several have had contact with previously confirmed cases. Three individuals have died. Two individuals including one healthcare worker are reported as asymptomatic. And two individuals including the first reported case from Medina are still being treated.  Although it is possible that the initial case, the 55M, may have died and is double counted and reported as Case 2 in the table below. It is difficult to reconcile this case list with unconfirmed media reports from September 7 of  a doctor’s death in Medina. [1]

Without more information, it is not possible to speculate whether there is one or more clusters, and whether or not these are family clusters or clusters of nosocomial infection.

 [1] http://www.flutrackers.com/forum/showthread.php?t=210885

 

MERS-CoV Outbreak Map – September 11, 2013

The eight countries reporting Middle East respiratory syndrome coronavirus (MERS-CoV) cases through September 11, 2013 are color coded by frequency of reported cases in the map below.  The numbers presented for all countries, with the exception of Saudi Arabia,  are presumed to be accurate.  The count from Saudi Arabia is uncertain due to poor case reporting from the Saudi Arabia Ministry of Health.  The local cluster outbreaks in the countries of France, Italy, Tunisia, and the United Kingdom are a result of the human-to-human infection. In each of these country clusters, the index case had recently returned from a trip to the Middle East. 

  World map of MERS--CoV cases as of September 11, 2013.