Is a younger cohort being infected with MERS on the Arabian Pennisula?

 A distinctive feature of the MERS  (Middle East Respiratory Syndrome) outbreak is the fact that confirmed case-patients are dominated by elderly individuals. Through February 28, 2014, the average age of a MERS-infected individual in Saudi Arabia was 52.3 years old (n=157).  A recent media report, however, suggests that the average of infected individuals is decreasing in Saudi Arabia.

“A Health Ministry source, speaking to Asharq Al-Awsat on the condition of anonymity, said that the average age of those being infected by the [MERS]  virus is decreasing, adding that over the past four months the average age of those infected was between 35 and 40 years of age” (link)

 

The statement is at variance with the data published by the Saudi Ministry of Health, although the age of infected individuals has been decreasing. Since March 1, 2014 the average age of an infected patient has only decreased to 46.8 years (n=32).  This decrease in average age is significant because many of the reported younger cases are health care workers in Jeddah with hospital- or contact-acquired infections.  Rather than infection from an animal reservoir, many of these infections are a result of human-to-human transmission. Several of the cases in Jeddah are asymptomatic and were only identified by contact tracing.  

The report today (link) of six health care workers (1 died) infected with MERS in the Emirate of Abu Dhabi demonstrates the infective nature of this coronavirus in a health care or hospital setting. Importantly, the media report indicates that all six of these individuals from the United Arab Emirates were younger than 40 years old.  There is now growing evidence that younger people are susceptible to the MERS coronavirus, at least in the context of hospital settings.

Hospital clusters of MERS-CoV cases, Jeddah, Saudi Arabia (map)

Several outbreaks of MERS (Middle East Respiratory Syndrome) have been reported in hospitals in Jeddah, Saudi Arabia, during this past week. According to a computer translation of a current media report (link), as many as 21 locally confirmed MERS cases have been identified in Jeddah.  These cases include nine cases at  King Abdulaziz University Hospital, seven at King Fahd Hospital,  and five at King Fahad Armed Forces Hospital.  These outbreaks include both doctors and nurses.   In addition, the report suggest that the Jeddah National Guard hospital, King Abdulaziz Medical City,  will also process MERS cases if necessary. The map below depicts the locations of these four hospitals in the Jeddah area.

The source of  the MERS coronavirus have been reported to be camels for some human cases. The source of infection for the cases in Jeddah is unclear, but at least several health care workers have been infected and one died indicating that some of these cases are a result of hospital acquired infections.   This current outbreak in Jeddah, the hospital outbreaks in 2013 in Al Hofuf in Eastern Saudi Arabia, (link) and the initial suspected hospital cluster in Jordan in 2012 (link) demonstrate that  the MERS coronavirus can be transmitted easily from human to human in hospital settings.

Map: Ebola Outbreak, West Africa, as of April 8, 2014

According to a World Health Organization report (link), through April 8, 2014, there have been at least 150 confirmed and suspected Ebola cases in three countries in West Africa;  Guinea, Liberia, and Mali, as depicted in the map below.

A French report (link) indicates that the 157 cases from Guinea are distributed among six prefectures as depicted in the map below.

The Ebola outbreak in West Africa continues and more confirmed cases should be expected.

Second wave of A(H7N9) cases in the People's Republic of China peaked in weeks 4-6, 2014

The graph below shows the frequency of A(H7N9) cases by week number (based onset date) since week 47 in 2013.  The infection rate started to increase in the last week of December, 2013 and the first week of January 2014. The case count continued to climb and peak between weeks 4 through 6. Since then, the number of H7N9 cases has been declining perhaps signaling an end to the second wave of H7N9 infections in China.

Disease Surveillance Apps for Cell Phones

Recent technological advances such as the Foldscope microscope will improve on-the-ground disease surveillance.[1]  The ubiquity of cell phones, even in remote locations, may provide another advance in data surveillance and monitoring of disease outbreaks. In an open access article in  the Online Journal of Public Health Informatics, researchers present a framework for data collections forms and apps for cell phones that could be used for real time epidemiological analysis.[2] They note that cell phones currently do not have the processing power for large data sets and that uploading the compiled data to cloud servers for epidemiological analysis and interpretation will be necessary.

The authors make several suggestions regarding the use of Android as an open source platform and testing existing apps suitable for epidemiological data collection and analysis. They conclude with a “proof of concept” application of a collection form for influenza cases, attempting to distinguish influenza from other forms of virus infection. While the influenza form may not be sufficient to differentiate influenza-like infections, it does provide a starting point for using cell phones for more sophisticated disease surveillance and monitoring in the future. 

[1] Foldscope: An origami microscope that will revolutionize disease surveillance

[2] Android and ODK based data collection framework to aid in epidemiological analysis