MERS-CoV vigilance rises in US

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MERS family cluster LOCALLY ACQUIRED FROM HUMANS FROM *UNKNOWN* SOURCE. **NOT GOOD!**

Middle East respiratory syndrome coronavirus (MERS-CoV) – update
D.O.N. / 2 December 2013

On 1 December 2013 WHO was informed of an additional three laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) in the United Arab Emirates

The three cases belong to a family in Abu Dhabi – a mother (32 years old), father (38 years old) and son (8 years old).

The earliest onset of illness was 15 November 2013.

Both the mother and father are in a critical condition in hospital.

They had no travel history, no contact with a known confirmed case and no history of contact with animals.

While hospitalized, the mother gave birth to a newborn child.

The 8 year old son, who has mild respiratory symptoms, was detected from epidemiological investigation of family contacts, and is being kept in hospital isolation.

Further investigations into close contacts of the family, the newborn baby, and healthcare workers are on-going.

Additionally, two previously laboratory-confirmed cases from Qatar died on 19 and 29 November 2013.

Globally, from September 2012 to date, WHO has been informed of a total of 163 laboratory-confirmed cases of infection with MERS-CoV, including 70 deaths.

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Volume 20, Number 6—June 2014
Dispatch
MERS Coronaviruses in Dromedary Camels, Egypt

Daniel K.W. Chu1, Leo L.M. Poon1, Mokhtar M. Gomaa, Mahmoud M. Shehata, Ranawaka A.P.M. Perera, Dina Abu Zeid, Amira S. El Rifay, Lewis Y. Siu, Yi Guan, Richard J. Webby, Mohamed A. Ali, Malik PeirisComments to Author , and Ghazi KayaliComments to Author
Author affiliations: The University of Hong Kong, Hong Kong, China (D.K.W. Chu, L.L.M. Poon, R.A.P.M. Perera, Y. Guan, M. Peiris); National Research Centre, Giza, Egypt (M.M. Gomaa, M.M. Shehata, D.A. Zeid, A.S. El Rifay, M.A. Ali); HKU-Pasteur Research Pole, Hong Kong (L.Y. Siu); St. Jude Children’s Research Hospital, Memphis, Tennessee, USA (R.J. Webby, G. Kayali)


Abstract
We identified the near-full-genome sequence (29,908 nt, >99%) of Middle East respiratory syndrome coronavirus (MERS-CoV) from a nasal swab specimen from a dromedary camel in Egypt. We found that viruses genetically very similar to human MERS-CoV are infecting dromedaries beyond the Arabian Peninsula, where human MERS-CoV infections have not yet been detected.


Middle East respiratory syndrome (MERS) is a pneumonic illness caused by a novel lineage C betacoronavirus (CoV). During September 2012–January 20, 2014, a total of 178 confirmed cases in humans resulted in 76 deaths (1). Primary infections have originated from countries within the Arabian Peninsula, although travel-associated cases and some secondary transmission have been reported in other countries. Limited human-to-human transmission has resulted in clusters of cases, some associated with multiple rounds of human-to-human transmission (2); the remaining sporadic cases in humans are presumed to be of zoonotic origin.
MERS-CoV genomes are phylogenetically classified into 2 clades, clade A and B clusters (3). The viral genomes detected in the earliest cases in humans (clade A cluster; EMC/2012 and Jordan-N3/2012) are genetically distinct from the others (i.e., clade B). The proximate source of human infection remains unclear. MERS-CoV is related to, but not identical to, viruses detected in bats (4,5). A short RNA fragment of the conserved viral polymerase region identical to MERS-CoV has been identified in Taphozous perforates bats, but these findings need to be confirmed (6).
Serologic studies of domestic livestock in Jordan, Saudi Arabia, Qatar, United Arab Emirates, and Egypt have found high seroprevalance to a MERS-like CoV in dromedary camels but not in other domestic animals (7–11). An investigation of domestic animals in the vicinity of 2 persons with related infections detected fragments of viral RNA in dromedary camels in contact with these persons but whether this represented transmission from a unidentified source to humans and dromedaries, transmission from humans to dromedaries, or vice versa is not clear (12).
The Study
We collected nasal swab specimens from 110 apparently healthy dromedaries (Camelus dromedarius) >6 years of age in abattoirs on 12 occasions during June–December 2013 (Table 1). Serum was collected from 52 of these dromedaries. Serum from 179 persons working in the camel abattoirs also was collected. Median age of these workers was 38 years (range 9–67 years), 84% were male, and 25 reported comorbidities (i.e., cardiovascular, renal, diabetes, other). Collection of the human specimens was approved by the ethics committee of the National Research Centre (Giza, Egypt), and Institutional Animal Care and Use Committee approval for collection of animal samples was obtained from St Jude Children’s Research Hospital (Memphis, TN, USA).
Real-time reverse transcription PCR (RT-PCR) targeting upstream of E gene of MERS-CoV was used for screening. The open reading frame (ORF) 1a gene was used for confirmation as recommended by the World Health Organization(www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua = 1). We also used a previously described pan-CoV nested PCR targeting the viral RNA-dependent RNA polymerase (RdRp) region (13), and PCR products were analyzed by sequencing (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page]).
We detected MERS-CoV RNA in 4 (3.6%) of 110 nasal swab specimens from dromedary camels with the upstream of E gene assay (cycle threshold [Ct] 23.2–36.8), confirmed by the ORF1a assay (Ct 23.2–39.1), fulfilling the World Health Organization criteria for diagnosis of MERS-CoV infection (Table 1). PCR was repeated from a fresh RNA extract to confirm positive results. One positive sample was obtained from a camel in an abattoir in the Nile Delta region in November 2013 and 3 other samples from an abattoir in Cairo in December 2013. Virus culture attempts in Vero E6 cells (ATCC CRL-1586) so far have been unsuccessful. The pan-CoV nested PCR detected CoV in an additional 8 specimens from dromedary camels. Sequence analyses of these additional positive samples showed that these amplicon sequences were genetically similar to those of bovine coronavirus (BCoV) (>99% nucleotide similarity). No animal was co-infected with MERS-CoV and BCoV-like viruses. The animals positive for either MERS-CoV or BCoV-like virus were all imported from Sudan or Ethiopia for slaughter.
Figure 1
Thumbnail of Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus (MERS-CoV). The viral RdRp region analyzed is a highly conserved region of the genome (covering motif B of RdRp) in nonstructural protein 12, at position 15202–15582 of MERS-CoV genome. The partial RdRp sequence of NRCE-HKU205 (GenBank accessi
Figure 1. . Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus...
On phylogenetic analysis, the partial RdRp sequences from MERS-CoV–positive samples NRCE-HKU205 and NRCE-HKU270 grouped within the cluster of MERS-CoV (Figure 1). The viral load in the other 2 specimens was too low to provide amplicons suitable for genetic sequencing. Viral RNA from NRCE-HKU205, the first positive specimen detected, was selected for more detailed genomic sequencing. We amplified viral RNA by PCR, using primers specific for overlapping regions of human MERS-CoV genome. PCR products were sequenced and assembled to produce a near full-length genome, lacking only the 3′ untranslated region (29908 nt, >99% of the MERS-CoV genome) (online Technical Appendix). The camel MERS-CoV genome has an overall nucleotide similarity of 99.2%−99.5% and deduced amino acid similarity of 98.0%–100% to ORFs of human MERS-CoV EMC/2012 (Table 2). The 5′ untranslated region and internal transcriptional regulatory sequences of NRCE-HKU205 were identical to published human MERS-CoV sequences.
Using MERS-CoV EMC/2012 as a reference sequence, we found 12 aa differences (residues 23, 26, 194, 434, 666, 696, 756, 886, 888, 918, 1158, and 1333 of EMC/2012) in the spike protein of dromedary MERS-CoV NRCE-HKU205 and 1 aa deletion (residue 1293 of EMC/2012) in the N terminal of the transmembrane domain. NRCE-HKU270 virus spike does not have a deletion of residue 1293. Of these, only residue 434 falls within the proposed receptor binding domain of spike protein, but it is located at the core (stem) subdomain of the receptor binding domain, suggesting that the camel MERS-CoV is still likely to bind human CD26 (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page] Figure). The biological impact of this difference and other amino acid differences needs to be fully explored.
Figure 2
Thumbnail of Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession no. KJ477102) were aligned with the corresponding human MERS-CoV (N = 25) sequences retrieved from GenBank (accession nos. as in Figure 1 legend). Phylogenetic trees were constructed by using MEGA5 (14) with neighbor-joining method. Numbers at nodes indicate bootst
Figure 2. . Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession no. KJ477102)...
We used phylogenetic analyses of the full genome, the spike gene, and nucleocapsid gene of MERS-CoV NRCE-HKU205 to compare with the same genes of other human MERS-CoVs (Figure 2). NRCE-HKU205 is within the clade A group but distinct from MERS-CoV EMC/2012, the only other MERS-CoV isolate available in our laboratory, excluding laboratory cross-contamination as an explanation for the detection of MERS-CoV from the dromedary specimens.
Using a previously described pseudoparticle neutralization assay (8), we detected antibodies against MERS-CoV (titer >20) in 48 (92.3%) of 52 dromedary serum samples with titers ranging from 20 to >640. Dromedary NRCE-HKU205 had a serum antibody titer of 640, possibly indicating a developing serologic response, as was noted previously (7), or the possibility of re-infection. Serum was not available from the other 3 animals with MERS-CoV RNA-positive nasal swab specimens.
Serum from 179 persons working in the dromedary abattoirs was negative for antibody to MERS-CoV. This finding includes 114 persons working in the 2 abattoirs from which the MERS-CoV–positive animal swab specimens were obtained.
Conclusions
Our findings confirm that MERS-CoV infects dromedary camels and that this virus is genetically very similar to a MERS-CoV that is infecting humans. The detection of MERS-CoV in nasal swab specimens of camels in 2 of 12 sampling occasions in abattoirs, taken together with the high seropositivity to MERS-CoV in dromedaries previously reported, supports the contention that MERS-CoV infection is common in dromedaries. Studies of dromedaries within camel herds and through the animal marketing system supplying abattoirs are needed to define the epidemiology of the infection. Our findings strengthen the plausibility that dromedaries may be a potential source of human infection and emphasize the need for detailed epidemiologic investigation of the exposure histories of humans with MERS. However, the lack of serologic evidence of infection of humans working in these abattoirs suggests that transmission of this virus to humans is uncommon. The detection of MERS-CoV in dromedaries in Egypt, in animals imported from Sudan and Ethiopia, suggests that cases may occur in humans beyond the Arabian Peninsula. MERS CoV diagnostic tests should be considered for all patients with unexplained severe pneumonia in Egypt, northeastern Africa, and beyond.
Dr Chu is a postdoctoral fellow at the Centre of Influenza Research at the University of Hong Kong. His primary research interests are virus ecology. evolution of CoVs, astroviruses, and zoonotic infections.
Acknowledgment
This research was supported by an internal research grant from the National Research Centre, Giza, Egypt; by a research contract from the National Institute of Allergy and Infectious Diseases contract HHSN266200700005C; and a grant from the European Community Seventh Framework Program (FP7/2007-2013) under project European management Platform for Emerging and Re-emerging Disease entities (grant agreement no. 223498) (EMPERIE).
References
World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update—as of 20 January 2014 [cited 2014 Feb 20].
www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_20_Jan_2014.pdf Adobe PDF fileExternal Web Site Icon
Assiri A, McGeer A, Perl TM, Price CS, Al-Rabeeah AA, Cummings DAT, Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369:407–16 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Cotten M, Watson SJ, Kellam P, Al-Rabeeah AA, Makhdoom HQ, Assiri A, Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study. Lancet. 2013;382:1993–2002 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Annan A, Baldwin HJ, Corman VM, Klose SM, Owusu M, Nkrumah EE, Human betacoronavirus 2c EMC/2012–related viruses in bats, Ghana and Europe. Emerg Infect Dis. 2013;19:456–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Ithete NL, Stoffberg S, Corman VM, Cottontail VM, Richards LR, Schoeman MC, Close relative of human Middle East respiratory syndrome coronavirus in bat, South Africa. Emerg Infect Dis. 2013;19:1697–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerg Infect Dis. 2013;19:1819–23 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Reusken CBEM, Haagmans BL, Müller MA, Gutierrez C, Godeke G-J, Meyer B, Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. Lancet Infect Dis. 2013;13:859–66 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Perera RA, Wang P, Gomaa MR, El-Shesheny R, Kandeil A, Bagato O, Seroepidemiology for MERS coronavirus using microneutralisation and pseudoparticle virus neutralisation assays reveal a high prevalence of antibody in dromedary camels in Egypt, June 2013. Euro Surveill. 2013;18:20574 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Reusken CB, Ababneh M, Raj VS, Meyer B, Eljarah A, Abutarbush S, Middle East respiratory syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013. Euro Surveill. 2013;18:20662 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Hemida MG, Perera RA, Wang P, Alhammadi MA, Siu LY, Li M, Middle East respiratory syndrome (MERS) coronavirus seroprevalence in domestic livestock in Saudi Arabia, 2010 to 2013. Euro Surveill. 2013;18:20659 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Meyer B, Müller MA, Corman VM, Reusken CBEM, Ritz D, Godeke G-D, Antibodies against MERS coronavirus in dromedary camels, United Arab Emirates, 2003 and 2013. Emerg Infect Dis [Internet]. 2014 Apr [cited 2014 Feb 22].
DOIExternal Web Site Icon
Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation. Lancet Infect Dis. 2014;14:140–5 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Chu DK, Leung CY, Gilbert M, Joyner PH, Ng EM, Tse TM, Avian coronavirus in wild aquatic birds. J Virol. 2011;85:12815–20 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Tamura K, Peterson D, Peterson N, Stecher G, Nei M, Kumar S. MEGA5: Molecular Evolutionary Genetics Analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011;28:2731–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Figures
Figure 1. . Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory...
Figure 2. . Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession...
Tables
Table 1. Results of testing nasal swab specimens from dromedary camels by RT-PCR for MERS-CoV and for other CoVs, Egypt, 2013
Table 2. Percentage identity between ORFs of dromedary camel MERS-CoV (NRCE-HKU205) and human MERS-CoV (EMC/2012) at the nucleotide and amino acid levels
Technical Appendix
Technical Appendix. . The sequencing method and the structure of Middle East respiratory syndrome coronavirus spike protein receptor binding domain and receptor protein complex. 399 KB Adobe PDF file
Suggested citation for this article: Chu DKW, Poon LLM, Gomaa MM, Shehata MM, Perera RAPM, Zeid DA, et al. MERS coronaviruses in dromedary camels, Egypt. Emerg Infect Dis [Internet]. 2014 Jun [date cited]. dx.doi.org/10.3201/eid2006.140299External Web Site Icon
DOI: 10.3201/eid2006.140299
1These authors contributed equally to this article.

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Middle East respiratory syndrome (MERS) is a pneumonic illness caused by a novel lineage C betacoronavirus (CoV). During September 2012–January 20, 2014, a total of 178 confirmed cases in humans resulted in 76 deaths

(1). Primary infections have originated from countries within the Arabian Peninsula, although travel-associated cases and some secondary transmission have been reported in other countries. Limited human-to-human transmission has resulted in clusters of cases, some associated with multiple rounds of human-to-human transmission (2); the remaining sporadic cases in humans are presumed to be of zoonotic origin.
MERS-CoV genomes are phylogenetically classified into 2 clades, clade A and B clusters (3). The viral genomes detected in the earliest cases in humans (clade A cluster; EMC/2012 and Jordan-N3/2012) are genetically distinct from the others (i.e., clade B). The proximate source of human infection remains unclear. MERS-CoV is related to, but not identical to, viruses detected in bats (4,5). A short RNA fragment of the conserved viral polymerase region identical to MERS-CoV has been identified in Taphozous perforates bats, but these findings need to be confirmed (6).
Serologic studies of domestic livestock in Jordan, Saudi Arabia, Qatar, United Arab Emirates, and Egypt have found high seroprevalance to a MERS-like CoV in dromedary camels but not in other domestic animals (7–11). An investigation of domestic animals in the vicinity of 2 persons with related infections detected fragments of viral RNA in dromedary camels in contact with these persons but whether this represented transmission from a unidentified source to humans and dromedaries, transmission from humans to dromedaries, or vice versa is not clear (12).

The Study
We collected nasal swab specimens from 110 apparently healthy dromedaries (Camelus dromedarius) >6 years of age in abattoirs on 12 occasions during June–December 2013 (Table 1). Serum was collected from 52 of these dromedaries. Serum from 179 persons working in the camel abattoirs also was collected. Median age of these workers was 38 years (range 9–67 years), 84% were male, and 25 reported comorbidities (i.e., cardiovascular, renal, diabetes, other). Collection of the human specimens was approved by the ethics committee of the National Research Centre (Giza, Egypt), and Institutional Animal Care and Use Committee approval for collection of animal samples was obtained from St Jude Children’s Research Hospital (Memphis, TN, USA).
Real-time reverse transcription PCR (RT-PCR) targeting upstream of E gene of MERS-CoV was used for screening. The open reading frame (ORF) 1a gene was used for confirmation as recommended by the World Health Organization(www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua = 1). We also used a previously described pan-CoV nested PCR targeting the viral RNA-dependent RNA polymerase (RdRp) region (13), and PCR products were analyzed by sequencing (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page]).
We detected MERS-CoV RNA in 4 (3.6%) of 110 nasal swab specimens from dromedary camels with the upstream of E gene assay (cycle threshold [Ct] 23.2–36.8), confirmed by the ORF1a assay (Ct 23.2–39.1), fulfilling the World Health Organization criteria for diagnosis of MERS-CoV infection (Table 1). PCR was repeated from a fresh RNA extract to confirm positive results. One positive sample was obtained from a camel in an abattoir in the Nile Delta region in November 2013 and 3 other samples from an abattoir in Cairo in December 2013. Virus culture attempts in Vero E6 cells (ATCC CRL-1586) so far have been unsuccessful. The pan-CoV nested PCR detected CoV in an additional 8 specimens from dromedary camels. Sequence analyses of these additional positive samples showed that these amplicon sequences were genetically similar to those of bovine coronavirus (BCoV) (>99% nucleotide similarity). No animal was co-infected with MERS-CoV and BCoV-like viruses. The animals positive for either MERS-CoV or BCoV-like virus were all imported from Sudan or Ethiopia for slaughter.
Figure 1
Thumbnail of Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus (MERS-CoV). The viral RdRp region analyzed is a highly conserved region of the genome (covering motif B of RdRp) in nonstructural protein 12, at position 15202–15582 of MERS-CoV genome. The partial RdRp sequence of NRCE-HKU205 (GenBank accessi
Figure 1. . Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus...
On phylogenetic analysis, the partial RdRp sequences from MERS-CoV–positive samples NRCE-HKU205 and NRCE-HKU270 grouped within the cluster of MERS-CoV (Figure 1). The viral load in the other 2 specimens was too low to provide amplicons suitable for genetic sequencing. Viral RNA from NRCE-HKU205, the first positive specimen detected, was selected for more detailed genomic sequencing. We amplified viral RNA by PCR, using primers specific for overlapping regions of human MERS-CoV genome. PCR products were sequenced and assembled to produce a near full-length genome, lacking only the 3′ untranslated region (29908 nt, >99% of the MERS-CoV genome) (online Technical Appendix). The camel MERS-CoV genome has an overall nucleotide similarity of 99.2%−99.5% and deduced amino acid similarity of 98.0%–100% to ORFs of human MERS-CoV EMC/2012 (Table 2). The 5′ untranslated region and internal transcriptional regulatory sequences of NRCE-HKU205 were identical to published human MERS-CoV sequences.
Using MERS-CoV EMC/2012 as a reference sequence, we found 12 aa differences (residues 23, 26, 194, 434, 666, 696, 756, 886, 888, 918, 1158, and 1333 of EMC/2012) in the spike protein of dromedary MERS-CoV NRCE-HKU205 and 1 aa deletion (residue 1293 of EMC/2012) in the N terminal of the transmembrane domain. NRCE-HKU270 virus spike does not have a deletion of residue 1293. Of these, only residue 434 falls within the proposed receptor binding domain of spike protein, but it is located at the core (stem) subdomain of the receptor binding domain, suggesting that the camel MERS-CoV is still likely to bind human CD26 (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page] Figure). The biological impact of this difference and other amino acid differences needs to be fully explored.
Figure 2
Thumbnail of Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession no. KJ477102) were aligned with the corresponding human MERS-CoV (N = 25) sequences retrieved from GenBank (accession nos. as in Figure 1 legend). Phylogenetic trees were constructed by using MEGA5 (14) with neighbor-joining method. Numbers at nodes indicate bootst
Figure 2. . Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession no. KJ477102)...
We used phylogenetic analyses of the full genome, the spike gene, and nucleocapsid gene of MERS-CoV NRCE-HKU205 to compare with the same genes of other human MERS-CoVs (Figure 2). NRCE-HKU205 is within the clade A group but distinct from MERS-CoV EMC/2012, the only other MERS-CoV isolate available in our laboratory, excluding laboratory cross-contamination as an explanation for the detection of MERS-CoV from the dromedary specimens.
Using a previously described pseudoparticle neutralization assay (8), we detected antibodies against MERS-CoV (titer >20) in 48 (92.3%) of 52 dromedary serum samples with titers ranging from 20 to >640. Dromedary NRCE-HKU205 had a serum antibody titer of 640, possibly indicating a developing serologic response, as was noted previously (7), or the possibility of re-infection. Serum was not available from the other 3 animals with MERS-CoV RNA-positive nasal swab specimens.
Serum from 179 persons working in the dromedary abattoirs was negative for antibody to MERS-CoV. This finding includes 114 persons working in the 2 abattoirs from which the MERS-CoV–positive animal swab specimens were obtained.

Conclusions
Our findings confirm that MERS-CoV infects dromedary camels and that this virus is genetically very similar to a MERS-CoV that is infecting humans. The detection of MERS-CoV in nasal swab specimens of camels in 2 of 12 sampling occasions in abattoirs, taken together with the high seropositivity to MERS-CoV in dromedaries previously reported, supports the contention that MERS-CoV infection is common in dromedaries. Studies of dromedaries within camel herds and through the animal marketing system supplying abattoirs are needed to define the epidemiology of the infection. Our findings strengthen the plausibility that dromedaries may be a potential source of human infection and emphasize the need for detailed epidemiologic investigation of the exposure histories of humans with MERS. However, the lack of serologic evidence of infection of humans working in these abattoirs suggests that transmission of this virus to humans is uncommon. The detection of MERS-CoV in dromedaries in Egypt, in animals imported from Sudan and Ethiopia, suggests that cases may occur in humans beyond the Arabian Peninsula. MERS CoV diagnostic tests should be considered for all patients with unexplained severe pneumonia in Egypt, northeastern Africa, and beyond.
Dr Chu is a postdoctoral fellow at the Centre of Influenza Research at the University of Hong Kong. His primary research interests are virus ecology. evolution of CoVs, astroviruses, and zoonotic infections.

Acknowledgment
This research was supported by an internal research grant from the National Research Centre, Giza, Egypt; by a research contract from the National Institute of Allergy and Infectious Diseases contract HHSN266200700005C; and a grant from the European Community Seventh Framework Program (FP7/2007-2013) under project European management Platform for Emerging and Re-emerging Disease entities (grant agreement no. 223498) (EMPERIE).
References
World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update—as of 20 January 2014 [cited 2014 Feb 20].
www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_20_Jan_2014.pdf Adobe PDF fileExternal Web Site Icon
Assiri A, McGeer A, Perl TM, Price CS, Al-Rabeeah AA, Cummings DAT, Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369:407–16 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Cotten M, Watson SJ, Kellam P, Al-Rabeeah AA, Makhdoom HQ, Assiri A, Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study. Lancet. 2013;382:1993–2002 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Annan A, Baldwin HJ, Corman VM, Klose SM, Owusu M, Nkrumah EE, Human betacoronavirus 2c EMC/2012–related viruses in bats, Ghana and Europe. Emerg Infect Dis. 2013;19:456–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Ithete NL, Stoffberg S, Corman VM, Cottontail VM, Richards LR, Schoeman MC, Close relative of human Middle East respiratory syndrome coronavirus in bat, South Africa. Emerg Infect Dis. 2013;19:1697–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerg Infect Dis. 2013;19:1819–23 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Reusken CBEM, Haagmans BL, Müller MA, Gutierrez C, Godeke G-J, Meyer B, Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. Lancet Infect Dis. 2013;13:859–66 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Perera RA, Wang P, Gomaa MR, El-Shesheny R, Kandeil A, Bagato O, Seroepidemiology for MERS coronavirus using microneutralisation and pseudoparticle virus neutralisation assays reveal a high prevalence of antibody in dromedary camels in Egypt, June 2013. Euro Surveill. 2013;18:20574 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Reusken CB, Ababneh M, Raj VS, Meyer B, Eljarah A, Abutarbush S, Middle East respiratory syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013. Euro Surveill. 2013;18:20662 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Hemida MG, Perera RA, Wang P, Alhammadi MA, Siu LY, Li M, Middle East respiratory syndrome (MERS) coronavirus seroprevalence in domestic livestock in Saudi Arabia, 2010 to 2013. Euro Surveill. 2013;18:20659 .
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Meyer B, Müller MA, Corman VM, Reusken CBEM, Ritz D, Godeke G-D, Antibodies against MERS coronavirus in dromedary camels, United Arab Emirates, 2003 and 2013. Emerg Infect Dis [Internet]. 2014 Apr [cited 2014 Feb 22].
DOIExternal Web Site Icon
Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation. Lancet Infect Dis. 2014;14:140–5 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Chu DK, Leung CY, Gilbert M, Joyner PH, Ng EM, Tse TM, Avian coronavirus in wild aquatic birds. J Virol. 2011;85:12815–20 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Tamura K, Peterson D, Peterson N, Stecher G, Nei M, Kumar S. MEGA5: Molecular Evolutionary Genetics Analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011;28:2731–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Figures
Figure 1. . Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory...
Figure 2. . Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession...
Tables
Table 1. Results of testing nasal swab specimens from dromedary camels by RT-PCR for MERS-CoV and for other CoVs, Egypt, 2013
Table 2. Percentage identity between ORFs of dromedary camel MERS-CoV (NRCE-HKU205) and human MERS-CoV (EMC/2012) at the nucleotide and amino acid levels
Technical Appendix
Technical Appendix. . The sequencing method and the structure of Middle East respiratory syndrome coronavirus spike protein receptor binding domain and receptor protein complex. 399 KB Adobe PDF file
Suggested citation for this article: Chu DKW, Poon LLM, Gomaa MM, Shehata MM, Perera RAPM, Zeid DA, et al. MERS coronaviruses in dromedary camels, Egypt. Emerg Infect Dis [Internet]. 2014 Jun [date cited]. dx.doi.org/10.3201/eid2006.140299External Web Site Icon
DOI: 10.3201/eid2006.140299
1These authors contributed equally to this article.
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Table of Contents – Volume 20, Number 6—June 2014

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Addresses for correspondence: Malik Peiris, School of Public Health, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong Special Administrative Region, China; ; Ghazi Kayali, Division of Virology, Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN, USAAddresses for correspondence: Malik Peiris, School of Public Health, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong Special Administrative Region, China; ; Ghazi Kayali, Division of Virology, Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN, USA
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[dothedd]

Volume 20, Number 6—June 2014
Dispatch
MERS Coronaviruses in Dromedary Camels, Egypt
Article Contents
The Study
Conclusions

Suggested citation for this article
Abstract
We identified the near-full-genome sequence (29,908 nt, >99%) of Middle East respiratory syndrome coronavirus (MERS-CoV) from a nasal swab specimen from a dromedary camel in Egypt. We found that viruses genetically very similar to human MERS-CoV are infecting dromedaries beyond the Arabian Peninsula, where human MERS-CoV infections have not yet been detected.

Middle East respiratory syndrome (MERS) is a pneumonic illness caused by a novel lineage C betacoronavirus (CoV). During September 2012–January 20, 2014, a total of 178 confirmed cases in humans resulted in 76 deaths (1). Primary infections have originated from countries within the Arabian Peninsula, although travel-associated cases and some secondary transmission have been reported in other countries. Limited human-to-human transmission has resulted in clusters of cases, some associated with multiple rounds of human-to-human transmission (2); the remaining sporadic cases in humans are presumed to be of zoonotic origin.  

MERS-CoV genomes are phylogenetically classified into 2 clades, clade A and B clusters (3). The viral genomes detected in the earliest cases in humans (clade A cluster; EMC/2012 and Jordan-N3/2012) are genetically distinct from the others (i.e., clade B). The proximate source of human infection remains unclear. MERS-CoV is related to, but not identical to, viruses detected in bats (4,5). A short RNA fragment of the conserved viral polymerase region identical to MERS-CoV has been identified in Taphozous perforates bats, but these findings need to be confirmed (6).
Serologic studies of domestic livestock in Jordan, Saudi Arabia, Qatar, United Arab Emirates, and Egypt have found high seroprevalance to a MERS-like CoV in dromedary camels but not in other domestic animals (7–11). An investigation of domestic animals in the vicinity of 2 persons with related infections detected fragments of viral RNA in dromedary camels in contact with these persons but whether this represented transmission from a unidentified source to humans and dromedaries, transmission from humans to dromedaries, or vice versa is not clear (12).

The Study
We collected nasal swab specimens from 110 apparently healthy dromedaries (Camelus dromedarius) >6 years of age in abattoirs on 12 occasions during June–December 2013 (Table 1). Serum was collected from 52 of these dromedaries. Serum from 179 persons working in the camel abattoirs also was collected. Median age of these workers was 38 years (range 9–67 years), 84% were male, and 25 reported comorbidities (i.e., cardiovascular, renal, diabetes, other). Collection of the human specimens was approved by the ethics committee of the National Research Centre (Giza, Egypt), and Institutional Animal Care and Use Committee approval for collection of animal samples was obtained from St Jude Children’s Research Hospital (Memphis, TN, USA).

CONTINUED: wwwnc.cdc.gov/eid/article/20/6/14-0299_article.htm#suggestedcitation

[dothedd]

UPDATE: 

wwwnc.cdc.gov/eid/article/20/6/14-0299_article.htm#suggestedcitation

[dothedd]

Mers 'Mystery': 11 medics taken ill in Jeddah...

"Manama: The emergency unit at King Fahad Hospital in the Saudi Red Sea city of Jeddah has been shut down as a precautionary measure amid reports that several people fell ill with Mers coronavirus.

The news comes as Saudi health authorities have reported the deaths of another two men and four new cases of Mers, bringing the death toll from the respiratory disease in the worst hit country to 66.
At least 11 medical staff have been reported to have contracted the virus, a spokesperson at the hospital said. “Six of them are hospitalised at the King Fahad hospital, two at the King Abdul Aziz hospital, one doctor at the King Faisal hospital and two other doctors at the University hospital and at the National Guard hospital,” the spokesperson said.

One of the patients is in critical condition, the spokesperson was quoted by Al Madinah newspaper.
Patients seeking treatment at the now shut down King Fahad emergency unit have been referred to other hospitals in the city.

The paper on Tuesday reported “deep mystery” over the status of the Jeddah hospital amid rumours that several people, including staff, fell ill with the Mers coronavirus.

Rumours claimed that 15 people working at King Fahad Hospital in Jeddah, including three doctors, four nurses and eight employees, had fallen ill, Al Madina said.."

YIKES! I'm guessing they all didn't get the Mers virus from a camel... It's possible that the second wave of Mers is spreading more easily H2H. Good thing NVAX already has a vaccine candidate ready to go

[dothedd]

These are the countries with Lab-confirmed Mers cases  

April 2012 - Present
France
Italy
Jordan
Kuwait
Oman
Qatar
Saudi Arabia
Tunisia
United Kingdom (UK)
United Arab Emirates (UAE)

[dothedd]

AHEAD OF PRINT: 

wwwnc.cdc.gov/eid/article/20/6/14-0299_article.htm#conclusions

Volume 20, Number 6—June 2014
Dispatch

MERS Coronaviruses in Dromedary Camels, Egypt


Daniel K.W. Chu1, Leo L.M. Poon1, Mokhtar M. Gomaa, Mahmoud M. Shehata, Ranawaka A.P.M. Perera, Dina Abu Zeid, Amira S. El Rifay, Lewis Y. Siu, Yi Guan, Richard J. Webby, Mohamed A. Ali, Malik PeirisComments to Author , and Ghazi KayaliComments to Author
Author affiliations: The University of Hong Kong, Hong Kong, China (D.K.W. Chu, L.L.M. Poon, R.A.P.M. Perera, Y. Guan, M. Peiris); National Research Centre, Giza, Egypt (M.M. Gomaa, M.M. Shehata, D.A. Zeid, A.S. El Rifay, M.A. Ali); HKU-Pasteur Research Pole, Hong Kong (L.Y. Siu); St. Jude Children’s Research Hospital, Memphis, Tennessee, USA (R.J. Webby, G. Kayali)


Abstract
We identified the near-full-genome sequence (29,908 nt, >99%) of Middle East respiratory syndrome coronavirus (MERS-CoV) from a nasal swab specimen from a dromedary camel in Egypt. We found that viruses genetically very similar to human MERS-CoV are infecting dromedaries beyond the Arabian Peninsula, where human MERS-CoV infections have not yet been detected.

Middle East respiratory syndrome (MERS) is a pneumonic illness caused by a novel lineage C betacoronavirus (CoV). During September 2012–January 20, 2014, a total of 178 confirmed cases in humans resulted in 76 deaths (1). Primary infections have originated from countries within the Arabian Peninsula, although travel-associated cases and some secondary transmission have been reported in other countries. Limited human-to-human transmission has resulted in clusters of cases, some associated with multiple rounds of human-to-human transmission (2); the remaining sporadic cases in humans are presumed to be of zoonotic origin.

MERS-CoV genomes are phylogenetically classified into 2 clades, clade A and B clusters (3). The viral genomes detected in the earliest cases in humans (clade A cluster; EMC/2012 and Jordan-N3/2012) are genetically distinct from the others (i.e., clade B). The proximate source of human infection remains unclear. MERS-CoV is related to, but not identical to, viruses detected in bats (4,5). A short RNA fragment of the conserved viral polymerase region identical to MERS-CoV has been identified in Taphozous perforates bats, but these findings need to be confirmed (6).
Serologic studies of domestic livestock in Jordan, Saudi Arabia, Qatar, United Arab Emirates, and Egypt have found high seroprevalance to a MERS-like CoV in dromedary camels but not in other domestic animals (7–11). An investigation of domestic animals in the vicinity of 2 persons with related infections detected fragments of viral RNA in dromedary camels in contact with these persons but whether this represented transmission from a unidentified source to humans and dromedaries, transmission from humans to dromedaries, or vice versa is not clear (12).

The Study
We collected nasal swab specimens from 110 apparently healthy dromedaries (Camelus dromedarius) >6 years of age in abattoirs on 12 occasions during June–December 2013 (Table 1). Serum was collected from 52 of these dromedaries. Serum from 179 persons working in the camel abattoirs also was collected. Median age of these workers was 38 years (range 9–67 years), 84% were male, and 25 reported comorbidities (i.e., cardiovascular, renal, diabetes, other). Collection of the human specimens was approved by the ethics committee of the National Research Centre (Giza, Egypt), and Institutional Animal Care and Use Committee approval for collection of animal samples was obtained from St Jude Children’s Research Hospital (Memphis, TN, USA).

Real-time reverse transcription PCR (RT-PCR) targeting upstream of E gene of MERS-CoV was used for screening. The open reading frame (ORF) 1a gene was used for confirmation as recommended by the World Health Organization(www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua = 1). We also used a previously described pan-CoV nested PCR targeting the viral RNA-dependent RNA polymerase (RdRp) region (13), and PCR products were analyzed by sequencing (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page]).

We detected MERS-CoV RNA in 4 (3.6%) of 110 nasal swab specimens from dromedary camels with the upstream of E gene assay (cycle threshold [Ct] 23.2–36.8), confirmed by the ORF1a assay (Ct 23.2–39.1), fulfilling the World Health Organization criteria for diagnosis of MERS-CoV infection (Table 1). PCR was repeated from a fresh RNA extract to confirm positive results. One positive sample was obtained from a camel in an abattoir in the Nile Delta region in November 2013 and 3 other samples from an abattoir in Cairo in December 2013. Virus culture attempts in Vero E6 cells (ATCC CRL-1586) so far have been unsuccessful. The pan-CoV nested PCR detected CoV in an additional 8 specimens from dromedary camels. Sequence analyses of these additional positive samples showed that these amplicon sequences were genetically similar to those of bovine coronavirus (BCoV) (>99% nucleotide similarity). No animal was co-infected with MERS-CoV and BCoV-like viruses. The animals positive for either MERS-CoV or BCoV-like virus were all imported from Sudan or Ethiopia for slaughter.

Figure 1
Thumbnail of Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus (MERS-CoV). The viral RdRp region analyzed is a highly conserved region of the genome (covering motif B of RdRp) in nonstructural protein 12, at position 15202–15582 of MERS-CoV genome. The partial RdRp sequence of NRCE-HKU205 (GenBank accessi
Figure 1. Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome coronavirus (MERS-CoV)The...
On phylogenetic analysis, the partial RdRp sequences from MERS-CoV–positive samples NRCE-HKU205 and NRCE-HKU270 grouped within the cluster of MERS-CoV (Figure 1). The viral load in the other 2 specimens was too low to provide amplicons suitable for genetic sequencing. Viral RNA from NRCE-HKU205, the first positive specimen detected, was selected for more detailed genomic sequencing. We amplified viral RNA by PCR, using primers specific for overlapping regions of human MERS-CoV genome. PCR products were sequenced and assembled to produce a near full-length genome, lacking only the 3′ untranslated region (29908 nt, >99% of the MERS-CoV genome) (online Technical Appendix). The camel MERS-CoV genome has an overall nucleotide similarity of 99.2%−99.5% and deduced amino acid similarity of 98.0%–100% to ORFs of human MERS-CoV EMC/2012 (Table 2). The 5′ untranslated region and internal transcriptional regulatory sequences of NRCE-HKU205 were identical to published human MERS-CoV sequences.

Using MERS-CoV EMC/2012 as a reference sequence, we found 12 aa differences (residues 23, 26, 194, 434, 666, 696, 756, 886, 888, 918, 1158, and 1333 of EMC/2012) in the spike protein of dromedary MERS-CoV NRCE-HKU205 and 1 aa deletion (residue 1293 of EMC/2012) in the N terminal of the transmembrane domain. NRCE-HKU270 virus spike does not have a deletion of residue 1293. Of these, only residue 434 falls within the proposed receptor binding domain of spike protein, but it is located at the core (stem) subdomain of the receptor binding domain, suggesting that the camel MERS-CoV is still likely to bind human CD26 (Technical Appendix Adobe PDF file [PDF - 399 KB - 1 page] Figure). The biological impact of this difference and other amino acid differences needs to be fully explored.

Figure 2
Thumbnail of Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camels. Genomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession no. KJ477102) were aligned with the corresponding human MERS-CoV (N = 25) sequences retrieved from GenBank (accession nos. as in Figure 1 legend). Phylogenetic trees were constructed by using MEGA5 (14) with neighbor-joining method. Numbers at nodes indicate bootst
Figure 2. Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camelsGenomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession noKJ477102) were aligned with...

We used phylogenetic analyses of the full genome, the spike gene, and nucleocapsid gene of MERS-CoV NRCE-HKU205 to compare with the same genes of other human MERS-CoVs (Figure 2). NRCE-HKU205 is within the clade A group but distinct from MERS-CoV EMC/2012, the only other MERS-CoV isolate available in our laboratory, excluding laboratory cross-contamination as an explanation for the detection of MERS-CoV from the dromedary specimens.
Using a previously described pseudoparticle neutralization assay (8), we detected antibodies against MERS-CoV (titer >20) in 48 (92.3%) of 52 dromedary serum samples with titers ranging from 20 to >640. Dromedary NRCE-HKU205 had a serum antibody titer of 640, possibly indicating a developing serologic response, as was noted previously (7), or the possibility of re-infection. Serum was not available from the other 3 animals with MERS-CoV RNA-positive nasal swab specimens.
Serum from 179 persons working in the dromedary abattoirs was negative for antibody to MERS-CoV. This finding includes 114 persons working in the 2 abattoirs from which the MERS-CoV–positive animal swab specimens were obtained.

Conclusions
Our findings confirm that MERS-CoV infects dromedary camels and that this virus is genetically very similar to a MERS-CoV that is infecting humans. The detection of MERS-CoV in nasal swab specimens of camels in 2 of 12 sampling occasions in abattoirs, taken together with the high seropositivity to MERS-CoV in dromedaries previously reported, supports the contention that MERS-CoV infection is common in dromedaries. Studies of dromedaries within camel herds and through the animal marketing system supplying abattoirs are needed to define the epidemiology of the infection. Our findings strengthen the plausibility that dromedaries may be a potential source of human infection and emphasize the need for detailed epidemiologic investigation of the exposure histories of humans with MERS. However, the lack of serologic evidence of infection of humans working in these abattoirs suggests that transmission of this virus to humans is uncommon. The detection of MERS-CoV in dromedaries in Egypt, in animals imported from Sudan and Ethiopia, suggests that cases may occur in humans beyond the Arabian Peninsula. MERS CoV diagnostic tests should be considered for all patients with unexplained severe pneumonia in Egypt, northeastern Africa, and beyond.

Dr Chu is a postdoctoral fellow at the Centre of Influenza Research at the University of Hong Kong. His primary research interests are virus ecology. evolution of CoVs, astroviruses, and zoonotic infections.

Acknowledgment
This research was supported by an internal research grant from the National Research Centre, Giza, Egypt; by a research contract from the National Institute of Allergy and Infectious Diseases contract HHSN266200700005C; and a grant from the European Community Seventh Framework Program (FP7/2007-2013) under project European management Platform for Emerging and Re-emerging Disease entities (grant agreement no. 223498) (EMPERIE).

References
World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update—as of 20 January 2014 [cited 2014 Feb 20].
www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_20_Jan_2014.pdf Adobe PDF fileExternal Web Site Icon
Assiri A, McGeer A, Perl TM, Price CS, Al-Rabeeah AA, Cummings DAT, Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369:407–16 and.
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PubMedExternal Web Site Icon
Cotten M, Watson SJ, Kellam P, Al-Rabeeah AA, Makhdoom HQ, Assiri A, Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study. Lancet. 2013;382:1993–2002 and.
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Annan A, Baldwin HJ, Corman VM, Klose SM, Owusu M, Nkrumah EE, Human betacoronavirus 2c EMC/2012–related viruses in bats, Ghana and Europe. Emerg Infect Dis. 2013;19:456–9 and.
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Ithete NL, Stoffberg S, Corman VM, Cottontail VM, Richards LR, Schoeman MC, Close relative of human Middle East respiratory syndrome coronavirus in bat, South Africa. Emerg Infect Dis. 2013;19:1697–9 and.
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Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerg Infect Dis. 2013;19:1819–23 and.
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Reusken CBEM, Haagmans BL, Müller MA, Gutierrez C, Godeke G-J, Meyer B, Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. Lancet Infect Dis. 2013;13:859–66 and.
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Perera RA, Wang P, Gomaa MR, El-Shesheny R, Kandeil A, Bagato O, Seroepidemiology for MERS coronavirus using microneutralisation and pseudoparticle virus neutralisation assays reveal a high prevalence of antibody in dromedary camels in Egypt, June 2013. Euro Surveill. 2013;18:20574 .
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Reusken CB, Ababneh M, Raj VS, Meyer B, Eljarah A, Abutarbush S, Middle East respiratory syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013. Euro Surveill. 2013;18:20662 .

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Hemida MG, Perera RA, Wang P, Alhammadi MA, Siu LY, Li M, Middle East respiratory syndrome (MERS) coronavirus seroprevalence in domestic livestock in Saudi Arabia, 2010 to 2013. Euro Surveill. 2013;18:20659 .
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Meyer B, Müller MA, Corman VM, Reusken CBEM, Ritz D, Godeke G-D, Antibodies against MERS coronavirus in dromedary camels, United Arab Emirates, 2003 and 2013. Emerg Infect Dis [Internet]. 2014 Apr [cited 2014 Feb 22].
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Haagmans BL, Al Dhahiry SH, Reusken CB, Raj VS, Galiano M, Myers R, Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation. Lancet Infect Dis. 2014;14:140–5 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Chu DK, Leung CY, Gilbert M, Joyner PH, Ng EM, Tse TM, Avian coronavirus in wild aquatic birds. J Virol. 2011;85:12815–20 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Tamura K, Peterson D, Peterson N, Stecher G, Nei M, Kumar S. MEGA5: Molecular Evolutionary Genetics Analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011;28:2731–9 and.
DOIExternal Web Site Icon
PubMedExternal Web Site Icon
Figures
Figure 1. Phylogenetic analyses of a partial RNA-dependent RNA polymerase (RdRp) sequence determined from samples from dromedary camels (Camelus dromedarius) NRCE-HKU205 and NRCE-HKU270 that were positive for Middle East respiratory syndrome...
Figure 2. Phylogenetic analyses of Middle East respiratory syndrome coronavirus (MERS-CoV) from dromedary camelsGenomic (A), spike (B), and nucleocapsid (C) sequences of the dromedary camel MERS-CoV NRCE-HKU205 (GenBank accession noKJ477102) were...
Tables
Table 1. Results of testing nasal swab specimens from dromedary camels by RT-PCR for MERS-CoV and for other CoVs, Egypt, 2013
Table 2. Percentage identity between ORFs of dromedary camel MERS-CoV (NRCE-HKU205) and human MERS-CoV (EMC/2012) at the nucleotide and amino acid levels
Technical Appendix
Technical Appendix. 399 KB Adobe PDF file
Suggested citation for this article: Chu DKW, Poon LLM, Gomaa MM, Shehata MM, Perera RAPM, Zeid DA, et al. MERS coronaviruses in dromedary camels, Egypt. Emerg Infect Dis [Internet]. 2014 Jun [date cited]. dx.doi.org/10.3201/eid2006.140299External Web Site Icon
DOI: 10.3201/eid2006.140299

[dothedd]

"IF MERS becomes anywhere near as easily transmissible as SARS was, then this could be a terrible situation. Interestingly, MERS and SARS both have broken-out in countries whose
governments can much more easily institute brutal quarantine measures than a western nation could, which was the only way China was able to keep SARS from spreading."
 

[dothedd]

Mers virus: Saudi seeks foreign firm's help

By Wam

Published Sunday, April 20, 2014


The official spokesman of the Saudi Ministry of Health Dr. Khalid Marghalani announced the imminent arrival of a specialised international company in the Kingdom to discuss the manufacturing of a vaccine against Middle East respiratory syndrome coronavirus (Mers-CoV), and support for existing efforts, confirming the presence of ongoing research to find a cure for this virus.

He said in a statement, carried by Saudi Press Agency (SPA), that the ministry called on the World Health Organisation and a group of experts from Europe, Canada, the USA, the countries of East Asia, the GCC states and other countries to meet at the end of this month to discuss the status of the Corona virus and the disease’s latest developments.

[dothedd]

Saudi To Develop MERS Vaccine To Combat Outbreak

An international firm is scheduled to visit the Kingdom to discuss the manufacturing of a MERS vaccine.

By Mary Sophia 14 hours ago
Share on email Share on print Share on facebook Share on twitter Share on linkedin Share on google_plusone_share

Saudi Arabia is in talks with a specialist international company to develop a vaccine against MERS-coronavirus, according to a senior health official.

A team of representatives from an international firm is scheduled to visit the Kingdom to discuss the manufacturing of a vaccine against the virus, Ministry of Health spokesperson Khaled Marghalani was quoted as saying in Saudi Gazette.

He also said that the members of the National Scientific Committee for Contagious Diseases and the Scientific Committee for Combating Infections will meet regularly to discuss the status of the virus.

The ministry is also meeting with experts from the World Health Organisation (WHO) and from other countries to keep track of the situation, according to state news agency SPA.

Although MERS cases have been reported throughout the GCC, Saudi Arabia has been the worst hit by the disease.

The country recorded a surge in the number of cases recently, sparking public concerns of an epidemic.

The Kingdom reported 13 new cases of MERS, bringing the total to 42 infections in five days, according to official data.

The MERS virus, which is believed to originate from camels, does not have a cure and is estimated to kill one third of those infected.

Authorities have said that the disease does not transmit easily among humans and might die out eventually.

The UAE too has been reporting a rise in MERS cases after a Filipino paramedic succumbed to the infection and died last week.

Around 16 health workers were affected after coming into contact with the deceased worker, the WHO said.

Health Authority-Abu Dhabi (HAAD) announced yesterday that three MERS affected health workers were cleared after a period of quarantine, state news agency WAM reported.

Despite an increase in cases, health authorities across the Gulf have asserted that the condition is under control and have not called for a travel ban.

IT WILL DEFINITELY BE INTERESTING TO KNOW THE NAME OF THE COMPANY!  A GOOD CHANCE IT IS NOVAVAX......

[dothedd]

Saudi officials see spike in MERS coronavirus cases
CNN
updated 1:20 AM EDT, Tue April 22, 2014

Abu Dhabi, United Arab Emirates (CNN) -- Saudi health officials are stepping up efforts to fight the Middle East respiratory symptom coronavirus, or MERS-CoV, after a recent spike in cases.
Saudi Arabia confirmed more than 50 cases of the virus in the past week, at least seven of which were fatal. The Saudi Health Ministry says 13 new cases were reported Monday alone, bringing the total to 257.

It is not clear why there was a sudden increase, said Dr. Abdullah Al-Asiri, assistant undersecretary at the Saudi Ministry of Health and a member of the Scientific Committee of Infectious Diseases.

"We have faced an increase in the number of cases around the same time last year at the end of winter," the Saudi Press Agency quotes him as saying.

Should I be concerned?

Last week, reports on social media said health care workers had refused to treat MERS-CoV patients. The government has since issued a statement saying ambulance services that refused would be suspended from work and investigated.

What is coronavirus? WHO: Coronavirus 'threat to the world'
Saudi officials have also called on the World Health Organization and a group of medical experts to meet at the end of this month to discuss the status of the virus.

In a prepared statement, Ministry of Health spokesman Khalid Marghalani said a drug company would be arriving in Saudi Arabia to discuss the production of a vaccine to fight the virus.
MERS-CoV was discovered in September 2012. The World Health Organization reported Sunday that 250 cases have been confirmed globally with 93 deaths worldwide.

A new cluster of the virus was reported in the United Arab Emirates this week, as were the first cases in Greece and Malaysia.

MERS-CoV comes from the same group of viruses as the common cold and attacks the respiratory system, the U.S.-based Centers for Disease Control and Prevention says. Symptoms, which include fever, cough and shortness of breath, can lead to pneumonia and kidney failure.

Although many of the cases have occurred on the Arabian Peninsula, people have died of the infection elsewhere, including in European countries and Tunisia in North Africa. However, all of the people involved contracted the disease in the Middle East before being diagnosed. Limited human-to-human transmission of the disease has also occurred in other countries.

Health officials do not know exactly how the virus spreads, and they stress hygiene, such as diligent hand-washing, to limit its spread.

The WHO has not recommended any MERS-related travel restrictions but says member countries should monitor any unusual respiratory infection patterns in travelers to the Arabian Peninsula.

After the spike in cases, Dr. Abdullah bin Abdulaziz Al-Rabiah stepped down as minister of health, state media reported Monday.

[dothedd]

A new virus in the same family as SARS -- found for the first time in humans in the past year -- has infected 49 people, most of them in the Middle East.

Of those, 27 people have died, the World Health Organization said Wednesday.

The virus previously was called the novel coronavirus, or nCoV. However, the WHO this week gave it a new name: Middle East respiratory syndrome coronavirus, or MERS-CoV.

Should I be concerned about new virus? Your questions answered...
It's part of a family called coronaviruses, which cause illnesses ranging from the common cold to SARS, or severe acute respiratory syndrome, as well as a variety of animal diseases. However, the new virus is not SARS.

The virus acts like a cold and attacks the respiratory system, the Centers for Disease Control and Prevention has said. But symptoms, which include fever and a cough, are severe and can lead to pneumonia and kidney failure. Gastrointestinal symptoms such as diarrhea have also been seen, according to the WHO.

MERS-CoV has been detected in humans in eight countries, the WHO said last week -- Saudi Arabia, Jordan, Qatar, the United Arab Emirates, France, Germany, Tunisia and the United Kingdom.

Earlier this month, the WHO reported two health care workers in Saudi Arabia became ill while treating patients.

Here are five things you need to know about MERS-CoV:

Widespread transmission hasn't been seen...

All the clusters of cases seen so far have been transmitted between family members or in a health care setting, the WHO said in a May 17 update. "Human-to-human transmission occurred in at least some of these clusters; however, the exact mode of transmission is unknown."
That means it's not yet known how humans contract MERS-CoV. But experts said there has been no evidence of cases beyond the clusters into communities.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, has said the infection is "very serious" but appears "very difficult to acquire."

According to the WHO, "The recent increase in cases may in part be related to increased awareness among the medical community; however, the demonstrated ability of this virus to transmit between humans and to cause large outbreaks has increased concerns about the possibility of sustained transmission."

Cases are connected to the Middle East

"All of the European cases have had a direct or indirect connection to the Middle East," the WHO said in the May 17 statement. "However, in France and the United Kingdom, there has been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a traveler recently returned from the Middle East."

New SARS-like virus poses medical mystery

Most of the cases so far are seen in older men with other medical conditions, experts have said. Precise numbers are difficult to ascertain as officials don't know how many people might contract a mild form of MERS-CoV.

Saudi Arabia leads the number of laboratory-confirmed cases, with 32 as of Tuesday, the CDC said.

No cases have been reported in the United States, but infectious disease experts have said they would not be surprised if it happens.

Underlying health conditions may make you more susceptible

A large number of patients have another condition, the WHO said, suggesting "increased susceptibility from underlying medical conditions may play a role in transmission." In addition, the infection has shown up "atypically" and without respiratory symptoms in people whose immune systems are compromised.

No travel warnings have been issued...

The WHO and CDC have not issued travel health warnings for any country related to the novel coronavirus.

But, in a travel notice, the CDC said it recommends that "U.S. travelers to countries in or near the Arabian Peninsula monitor their health and see a doctor right away if they develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath. They should tell the doctor about their recent travel."

In addition, those who traveled to the Middle East should see their health care provider if they develop a fever and respiratory symptoms such as a cough or shortness of breath within 10 days of returning from the Arabian Peninsula or surrounding nations, according to the CDC.

There are no treatments and no vaccine

So far, those with MERS-CoV have received supportive treatments to relieve their symptoms.


i2.cdn.turner.com/cnn/dam/assets/130218065351-exp-early-cohen-coronavirus-00001107-story-body.jpg


www.cnn.com/2013/05/17/health/coronavirus-5-things/index.html

[dothedd]

Concerns Spread as New Saudi MERS Cases Spike

Some Saudi ambulance crews refused to transport suspected victims, while drugstores are fast selling out of protective face masks – as the toll of a lethal new viral disease continues its steep month-long climb in Saudi Arabia.

As angry complaints soared, Saudi health officials confirmed 42 new cases of the Middle East Respiratory Syndrome-Coronavirus, or MERS-CoV, in the kingdom over the last week, seven of them fatal.

MERS globally took 1-½ years since its September 2012 discovery in the Middle East to reach its first 200 cases; last week alone, however, the cases jumped by about one-fourth. That includes, besides the new Saudi cases, another large cluster in the United Arab Emirates. The disease sickens mainly with respiratory infections.

Yemen, Malaysia, the Philippines and Greece also reported their first cases last week, all linked to travelers from the Gulf.

Unusually persistent clusters in the Red Sea Saudi city of Jeddah, where many of the latest infected are health-care workers, have disease experts particularly concerned. Up to now the virus, which has camels as at least one of its hosts, has spread only in limited clusters person-to-person.

Without more data from Saudi Arabia, outside infectious-disease experts can only guess if the many Jeddah cases now represent repeated and serious breakdowns in infection control among health workers, said Ian M. Mackay, a virologist at the Australian Infectious Disease Research Center at the University of Queensland.

“Or else, are we seeing a changed variant of MERS-CoV – a virus that has changed and is capable of more efficient human-to-human transmission?” Mr. Mackay asked, in a question echoed by other outside disease experts this week.

There was some, limited good news. The fatality rate of MERS appears to have dropped about one-in-two cases at the time of the disease’s discovery to what Mr. Mackay said was one-in-three cases, possibly because health officials have stepped up testing for the virus.

And there was no word yet on the first two cases in Southeast Asia spreading from person-to-person there.

In Saudi Arabia, the surge in cases brought MERS squarely to the front of national attention. Health officials did not respond to calls and emails seeking comment Sunday.

The kingdom’s state news agency meanwhile announced Sunday that a team of experts from the World Health Organization, the United States and elsewhere would come at the end of the month to help, although it gave no details.

The kingdom also had made contact with an international pharmaceutical company about developing a vaccine, the state news agency said, again without giving details.

Health experts have said developing a human vaccine would be time-consuming and perhaps prohibitively expensive. Some have said developing a vaccine to inoculate camels against MERS could be more effective in the long run.

The Ministry of Health carried notices on Twitter and YouTube about hand-washing and other means of limiting the spread of the virus.

Over the weekend, the kingdom’s official Red Crescent health service announced that ambulance crews had no choice but carry suspected MERS cases.

That was after an audio recording circulated on social media of ambulance workers reportedly refusing to carry a man believed ill with MERS. “Just put a double layer of masks on,” the dispatcher told the workers, who stuck to their refusal.

On social media, doctors and nurses tweeted of growing numbers of colleagues sickened. Some accused the Health Ministry of concealing the true number of cases, and playing down the overall severity of the outbreak. “Health Minister: You have to at least declare an emergency…so it is possible to activate the protocols of infection,” one Jeddah doctor tweeted. “We don’t want to lose more souls.”

On Saturday, Saudi Arabia’s Okaz newspaper carried what it said was a notice from the Health Ministry threatening health workers with prison for disclosing any health ministry information. That followed a Cabinet order last week, directing Saudi news media to quote only official sources on the disease.

With the report of a gag order on Saudi health workers, “people are past fury, and looking for ways of protection,” one Jeddah woman said by email. Like many, she was tweeting advice to fellow Saudis at large on protective measures against MERS, and urging public reporting of any price-gouging on remaining supplies of face masks.

[dothedd]

Sharp Rise In MERS Cases May Mean The Virus Is Evolving

April 21, 2014 7:38 PM ET

A medical worker stands outside the emergency room of King Fahd Hospital, in Jeddah, Saudi Arabia, April 9. Authorities closed the ER department after two health workers at the hospital caught the Middle East Respiratory Syndrome.

There's growing concern that the Middle East Respiratory Syndrome may have entered a new phase in the way it's spreading in Saudi Arabia.

The country has reported a sharp uptick in MERS cases over the past week. Since the deadly respiratory virus was first detected in September 2012, a total of 244 cases have been found in Saudi Arabia. About 50 of those cases were reported in the past six days.

Neighboring United Arab Emirates has also reported a rise in cases in the past week.

Amid the flurry of new infections, the Saudi government said Monday it had removed the country's health minister.

The spike in cases, especially among health care workers, could be a signal that the virus has reached a tipping point and could be ready to spread out of the region, says Dr. Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota.

"It took us over a year to get the first hundred cases of this viral infection," Osterholm tells Shots. "Now in just the last two weeks, we've had a hundred cases. ... There's a major change occurring that cannot just be attributed to better case detection. Something's happening."

MERS is a viral infection that causes pneumonia-like symptoms, including a fever, cough and shortness of breath. There's neither a vaccine nor a cure for MERS. And so far, about 30 percent of people with known infections have died.

The MERS virus has been hanging out in camels for more than two decades, researchers have found. Many people who caught MERS in 2012 and 2013 had worked directly with camels or had recently eaten camel meat or drunk camel milk.

What's troublesome right now, Osterholm says, is that several of the new clusters of MERS cases are not among camel herders, but rather among health care workers. This could indicate that the virus is changing, he says, so that it can move more easily between people.

"When humans readily transmit to humans, that's what will cause a worldwide outbreak," Osterholm says. "We are very concerned that ... with what we've seen over the last two weeks ... we may be at that point now."

The majority of the MERS cases, so far, have been in Saudi Arabia, although the virus has also turned up in several other Middle Eastern countries. And a few travelers have brought it to the U.K. and Europe. Last week, cases were also imported into Greece and Malaysia.

Saudi Arabia needs to be more aggressive in combating the problem, Osterholm says. And it needs to be more transparent about what's happening with the disease.

"It's time for the world to wake up and demand that the Middle East do the kind of job that we need done to stop this transmission [of MERS]," he says, "and to protect the rest of the world."

[dothedd]

QUOTES:  Tell the story!

"The News doesn't tell you how many days it takes to manifest itself. Hey if its six weeks, a traveler could infect half the world before anyone had the Idea that this was the Virus."


"Respiratory viruses are faster than six weeks. That's very very long. You're looking at one to two weeks (max). But it can still spread a whole lot in those two weeks. I mean you and I get a cold and we still go to work and pay bills and shop...and in the early stages of these respiratory diseases, you really can't tell a coming cold or flu from the new novel Middle eastern coronavirus. And seeing as anyone can be anywhere in the world in a day, it's not impossible for it to go elsewhere. Still, we would know right away if there was a large scale outbreak. The global economy is so fragile now, the last thing they want is an outbreak. It will slow all business down. Bad bad bad."

"Sorry, Saudi Arabia's too busy building a 1 kilometer-tall building to invest on things like infrastructure and containing a potentially deadly pandemic."

"Change Saudi Arabia to 'china' and MERS to 'bird flu' and it is deja vu all over again. "They need to be more aggressive and more transparent". Sounds like nobody's learned the lessons of the past."

"Well, we do seem to have a new definition for transparency these days."

"Yes Totaly Opaque"

" Nature will 'thin the herd' sooner or later when the population gets too large."

"Thanks to Reuters I have been following this for well over a year. It will prove interesting to see how well it is contained."

"Funding cuts to the National Institutes of Health have slowed disease research. The budget sequestration has forced labs to close and workers to be laid off. The Centers for Disease Control is also struggling with reduced funding. Perhaps it is time to invest in protection against MERS, influenza, SARS, multi-drug resistant tuberculosis. Research on disease detection and drug development by the NIH and the CDC is our best hope of protecting our selves and our society against these diseases. After all, Jeddah is only a plane flight away."

"Indeed the spreading of such a disease is much easier with the airline industry. it could potentially spread world wide as during the SARS outbreak in Hong Kong in 2003, The disease spread in Hong Kong from a mainland doctor who infected 16 other people, and those people traveled to Canada, Singapore, Taiwan, and Vietnam, spreading SARS to those locations.

We can check for bombs and weapons on aircraft but disease can't be detected."

[dothedd]

17 New MERS Cases In Saudi Arabia
Reuters
Posted: 04/22/2014 10:05 am EDT - Updated: 04/22/2014 10:59 am EDT

RIYADH, April 22 (Reuters) - Saudi Arabia has discovered another 17 cases of Middle East Respiratory Syndrome (MERS), as the total number of confirmed infections of the SARS-like disease has jumped by a third in the kingdom in the past week.

King Abdullah replaced the health minister, Abdullah al-Rabeeah, on Monday amid growing public disquiet at the spread of the disease, which was discovered two years ago and kills around a third of sufferers.

Rabeeah said on Sunday he did not know why there had been a surge but said it might be part of a seasonal pattern since there had also been a rise in infections last April and May.

However, the jump is of particular concern as Saudi Arabia is expected to have a large influx of pilgrims from across the world in July during the Muslim fasting month of Ramadan, followed in early October by the arrival of millions of people to perform the annual Haj in Mecca and Medina.

Jeddah, Saudi Arabia's second-largest city where many of the new cases have been discovered, is the main entry point for pilgrims visiting nearby Mecca, site of the holiest places in Islam but where there have been no confirmed cases so far.

Last year's Haj passed without any new infections being identified.

The 17 new cases, announced late on Monday on the Health Ministry website, bring the total number of Saudi infections to 261, of whom 81 have died. Combined with the other 49 cases announced in recent days, they represent a jump of 34 percent in the number of laboratory confirmed infections within a week.

Seven of the 17 new cases were in Jeddah. Six were in Riyadh, including one who died, while three were in Medina and one was in the northern city of Tabuk.

Saudi authorities last week issued several statements aimed at reassuring the public that there was no immediate cause for concern at the latest outbreak and that it had not met international definitions of an epidemic.

However, Labour Minister Adel Fakieh, who has been appointed as acting health minister, was shown in several newspapers on Tuesday touring one of the main hospitals in Jeddah, a display that seemed aimed at countering accusations from some Saudis on social media that the authorities had not taken the situation seriously enough.

Rabeeah said on Sunday Saudi Arabia was still opening its borders for foreign visitors, including pilgrims, and that the authorities were taking "all the scientific precaution measures to ensure the safety and well being of our nation".

He said there was not yet any medical reason to change the preventative measures already in place, such as travel restrictions or closures of some medical facilities where clusters of cases have occurred, to contain the spread.

MERS has no vaccine or anti-viral treatment, but international and Saudi health authorities say the disease, which originated in camels, does not transmit easily between people and may simply die out.

Jeddah, like most Saudi cities, has areas within its boundaries where camels are free to graze.

Fakieh has become a prominent figure in Saudi politics in recent years after pushing sweeping reforms in employment policy aimed at getting more young Saudis into jobs.

(Saudi Arabia is playing Russian roulette with the WORLD!)

[Deleted]

This is soooo scary!!!! 

[dothedd]

It is indeed LONE and it is going to get SCARIER! 



Stranded OFWs in Saudi susceptible to MERS-CoV

MANILA (Mindanao Examiner / Apr. 23, 2014) - The Middle East-based overseas Filipino workers’ rights group Migrante-Middle East expressed alarm over the safety of Filipino workers stranded in Saudi Arabia following the breakout of there Middle East Respiratory Syndrome Coronavirus.

It said even the old and sick OFWs, including children of those stranded, are more susceptible to MERS-CoV. Saudi has ordered the distribution of vaccines to fight and contain the spread of the deadly disease.

Just recently, four people, among them two Filipino medical staffs in hospitals in United Arab Emirates, were tested positive for the virus. There were also reports of MERS-CoV cases in Doha, Qatar.

“This situation requires an immediate action by the Philippine government through its diplomatic posts not only in Saudi Arabia but in other mid-east countries where there are MERS-CoV spread and huge OFWs concentration,” John Leonard Monterona, Migrante Middle East regional coordinator, said in a statement sent to the regional newspaper Mindanao Examiner.

Monterona cited that in UAE for instance, the host government already raised ‘Orange’ alarm which means its citizen and expatriates were advised to wear mask especially going to public places.

He said Saudi has sent out text messages cautioning its citizens and the millions of expatriates, including himself, about the disease.

Monterona said the Philippine Consulate in Jeddah should conduct not only information dissemination and education campaign on how to avoid MERS-CoV, but also to conduct medical missions and monitor the health condition of an estimated 200 stranded OFWs, some with children, who have been staying since October last year inside the deportation facility there.

“We likewise call on Philippine Embassy officials in Riyadh to do the same,” Monterona said, adding that there are around 100 stranded OFWs temporarily staying at embassy-rented accommodation, while there are 40 women and children at the Bahay Kalinga, also in Riyadh.

“We are urging President Aquino to issue a clear marching order to the Department of Foreign Affairs and the Department of Health to quickly attend on the medical needs of the distressed and stranded OFWs in Saudi Arabia and other Middle East countries; form a medical team and deploy them in MERS-CoV hit countries where there are large concentration of OFWs, distressed and stranded,” he said.

Monterona also called on the Aquino government to seriously attend on the repatriation of the distressed and stranded OFWs in Saudi Arabia.

“We need action from his administration not just mere words of praises to OFWs whom the government hails as modern heroes due to its economic contribution through their billion dollars remittances,” Monterona said.

[dothedd]

Saudi Arabia Sees 11 New MERS Cases as Virus Sweeps to Mecca

Apr 23, 2014 – 1 Hour ago

Saudi Arabia reported another 11 cases of a potentially deadly respiratory virus, including the first in the Muslim holy city of Mecca.

Six of the people to have newly contracted Middle East Respiratory Syndrome, or MERS, were in Jeddah, the kingdom’s largest city, with another four in the capital, Riyadh, and one in Mecca, according to a health ministry statement. That brings the total number of cases in the country to 272.

“We are concerned about these new cases in health facilities” in Saudi Arabia and United Arab Emirates, said Tarik Jasarevic, a spokesman forWorld Health Organization, in an e-mail. “We are unaware at this point of the specific types of exposure in the health care facilities that have resulted in transmission of these infections.”

At least 93 people have died of the disease since it emerged in Saudi Arabia in September 2012, according to the WHO. MERS, which has been linked to contact with camels, is in the same family as the SARS virus that killed about 800 people worldwide after first appearing in China.

Saudi Arabia is consulting experts from Germany, France, the U.K. and the U.S. on how to combat the virus. The kingdom removed Health Minister Abdullah al-Rabeeah from office on April 21 as it moved to fight the outbreak, replacing him on an acting basis with Labor Minister Adel Faqih.

Minor Symptoms:
Although most people infected with the virus have either no or minor symptoms and are not infectious, critical information gaps remain to better understand the transmission of the virus as well as the route of infection, Jasarevic said.

“Every effort is being made to understand its current behavior and any potential alteration in its behavior,” Assistant Deputy Minister of Health Mohammed Zamakhshary said in an interview of the coronavirus that causes the illness.

In Jordan, a 25-year-old Saudi citizen tested positive for the disease and is in a stable condition, the state-run Petra news agency said yesterday.

“We believe MERS is a zoonotic virus, meaning that the virus comes from animals, namely camels, and is transmitted to humans,” said Maria Van Kerkhove, a senior research fellow at Imperial College in London and a technical expert for the WHO. “The virus can also be transmitted from human to human, which we have seen between family members and health-care workers caring for MERS patients.”

The virus has spread to Southeast Asia, killing a Malaysian man who visited Saudi Arabia, the WHO said last week. A Filipino health-care worker returning from Abu Dhabi who initially tested positive for MERS was shown not to have the virus when a second test was carried out.

Saudi Arabia expects millions of pilgrims from around the world to perform the annual Haj in Mecca and Medina in early October.

[dothedd]

Sharp rise in MERS cases, many human spread, has world health experts concerned

Last Updated: Apr 23 3:13 PM ET

A sharp rise in cases of MERS in the Middle East has experts concerned, especially as 75% of the cases are said to have spread via human contact.

The World Health Organization is expressing concern about the recent sharp rise in MERS cases in Saudi Arabia and the United Arab Emirates.

The organization is particularly worried about what it calls two significant outbreaks in health-care facilities.

The global case count of infections with MERS virus has skyrocketed this month, with about 140 new cases reported since the beginning of April.

To put that in context, that represents about 41% of all cases of MERS diagnosed since the first known infections in April of 2012.

The WHO statement says about three quarters of the recently diagnosed cases involve person-to-person spread of the virus, with most of these cases being infected in hospitals.

The WHO says it has offered to pull together teams of international experts to help Saudi Arabia and the United Arab Emirates deal with the outbreaks.

The statement, issued by the WHO’s Eastern Mediterranean Regional Office, says the global health agency believes there are “critical information gaps” related to how the virus is transmitting to and among people.

“WHO is unaware at this point in time of the specific types of exposure in the health-care facilities that have resulted in transmission of these infections, but this remains a concern,” the statement says.

Many of the most recent cases have been health-care workers. Local media have reported that some doctors in Jeddah have quit rather than treat MERS patients. There appears to be a large hospital outbreak in Jeddah.

Earlier this week the country’s executive council fired the health minister. While no official reason was given, it is believed dissatisfaction with his handling of the MERS outbreak was behind the move.

To date the WHO has confirmed 253 MERS infections and 93 deaths. But the organization’s tally lags far behind actual the number of cases reported by affected countries. A combination of WHO and country reports puts the global count at about 350 case, and more than 100 deaths.

[dothedd]

QUOTES: 4 23 14

Bloomberg health care article

“We believe MERS is a zoonotic virus, meaning that the virus comes from animals, namely camels, and is transmitted to humans,” said Maria Van Kerkhove, a senior research fellow at Imperial College in London and a technical expert for the WHO. “The virus can also be transmitted from human to human, which we have seen between family members and health-care workers caring for MERS patients."

"There does not seem to be a consistent theme with news "facts".
The culture of "The Kingdom" does not help.
Some question the counts of MERS cases, redundancy and maybe not reported.
Have to wonder about that spike in healthcare workers
WHO urges "droplet" precautions
WHO stated "It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms."

If that is true, does that make H2H more easy, from "droplet" contact?
WHO stated: "Airborne precautions should be applied when performing aerosol generating procedures."
If healthcare workers are impacted, how about family, co-workers, commuters...

And the H7N9 continues to brew in the viral cauldron...."


"Scary doesn't even come close never mind concerned. IMO Mecca is now infected. I read a article yesterday describing that the WHO has been complaining about being "under informed". That 10 cases may be one hundred that they didn't know the age or sex of certain patients, pretty much called it gross lack of info. The article said when SARS appeared in China it was the total opposite and were worried about patient privacy being threatened. If this is true and it's obviously H2H, Mecca's Hajj is going to infect every country on every continent...

[dothedd]

Gush of MERS cases sparks speculation about causes
CIDRAP News | Apr 23, 2014
Filed Under: MERS-CoV

With few data available, experts are at a loss to explain the rising tide of MERS-CoV (Middle East respiratory syndrome coronavirus) cases in Saudi Arabia and the United Arab Emirates (UAE). But when it comes to speculation, two leading possibilities mentioned are a change in the virus and a seasonal pattern to its transmission.

Saudi Arabia has reported more than 100 cases since the beginning of April, many of them in a healthcare-related outbreak in the Red Sea port of Jeddah. The number of recent cases in the UAE, meanwhile, is unclear but seems to be well above 25, including 14 that, according to the World Health Organization (WHO), stemmed from one healthcare worker (HCW).

In a statement today, the WHO noted that about 75% of the recent cases are secondary ones resulting from human-to-human transmission, with the majority occurring in healthcare settings, often in HCWs. Acknowledging "critical information gaps," the agency said it is unaware of what specific kinds of exposures have sparked the cases in healthcare facilities.

Experts are quick to emphasize that very little is known so far about the outbreaks in Saudi Arabia and the UAE, making it impossible to reach any conclusions about their cause as yet.

"These cases are just being reported and information regarding them is trickling in to WHO," said David Swerdlow, MD, leader of MERS activities at the US Centers for Disease Control and Prevention (CDC). "As we learn more, we can get a sense of the nature of these newly reported cases. For example, is this just seasonality, an increase in cases because of a hospital outbreak or a change in the efficiency of how the virus is transmitted?

"At this time, there is no conclusive indication the virus has adapted enough to sustain human-to-human transmission, something CDC is monitoring closely," he added.

Possibility of viral evolution
Allison McGeer, MD, a microbiologist and infectious diseases consultant at Mt. Sinai Hospital in Toronto, agrees that there is too little information to do more than speculate for now, but she sees some signs that suggest the possibility that the virus is changing. She was part of a team that traveled to Saudi Arabia last year and advised the government about its response to MERS-CoV.

In an interview, McGeer, who led efforts to stop the SARS (severe acute respiratory syndrome) coronavirus outbreak in Toronto in 2003, compared the Jeddah outbreak with the outbreak in Al-Ahsa (also written Al-Hasa) in eastern Saudi Arabia a year ago. That one involved 23 confirmed and 11 probable cases in several hospitals, according to a June 2013 report in the New England Journal of Medicine (NEJM).

McGeer said that although information is lacking, the Jeddah outbreak "seems like a multi-institutional, really complicated outbreak. . . . It's clear that there are a substantial number of healthcare workers involved."

But the two outbreaks, she said, seem to differ in at least one way: "Compared to last year, the attack rate in healthcare workers appears to be higher, and I don't think that that is related to more testing. One of the striking things about the Al-Hasa outbreak was that the attack rate in healthcare workers was relatively low compared to the rate in patients.

"This ratio of healthcare workers to patients looks different now, and that raises the issue of whether the virus is changing," she added. "To me that's the critical issue that needs to be answered."

A spring thing?
Connie Savor Price, MD, chief of infectious diseases at Denver Health and Hospital, speculates that there may be something about MERS-CoV that makes it spread more readily in spring.

She noted that the first known outbreak of MERS-CoV occurred in a Jordan hospital in the spring of 2012. (The virus had not yet been discovered at the time, but months later, analysis of stored clinical samples revealed that MERS-CoV was the cause.)

"Of course I'm going on a really, really limited number of outbreaks, but, among the larger healthcare outbreaks: Jordan hospital outbreak peaked in April, as did Al-Hasa outbreak, and now we have this recent activity in Jeddah," Price told CIDRAP News.

Further, she observed that SARS, another coronavirus, peaked in March and April of 2003 and was largely gone by summer.

"[I'm] still perplexed why no one got sick at Hajj last fall," she added. "Perhaps spring is special for MERS. We do know that other coronaviruses have a marked winter/spring seasonality."

"That's just one very theoretical idea," Price cautioned. "Without detailed information on the recent Saudi cases, it's really hard to do anything but guess. One could imagine it's a combination of factors—in addition to the theory above, sheer lack of data on transmission to guide best practice, infection control lapses, super-spreaders, evolving virus becoming more fit to spread human-to-human. We could guess endlessly."

McGeer also mentioned the possibility of a seasonal pattern to MERS-CoV transmission. She speculated about one possible contributing factor. Recent studies have indicated that MERS-CoV is fairly widespread in camels on the Arabian Peninsula, and it seems to be more common in young camels than adults. She noted that camels usually give birth in spring, which means a higher population of young camels at that time of year, perhaps raising the risk of human MERS outbreaks.

German virologist Christian Drosten of the University of Bonn hinted at the same possibility in a news story in the Mar 28 issue of Science. He said young camels may contract MERS shortly after birth and be in their most infectious condition in the spring.

Infection control issues
But even if there were a known seasonal aspect to MERS transmission, it wouldn't explain why the current outbreak in Jeddah is so much larger than the Al-Ahsa one a year ago, said McGeer.

"The Kingdom of Saudi Arabia has perfectly good infection control practices, they know how to do that well, they did a great job with Al-Hasa last year, yet this outbreak appears to be substantially larger than Al-Hasa was," she said.

"So how this virus got past what I think generally are competent infection control people and caused a larger outbreak than was seen last year, I think really raises an issue about whether the virus has changed," McGeer added.

Another possibility that some have mentioned is the emergence of "super spreaders," meaning infected people who spread the virus to many others. The UAE MERS patient who infected 14 others appears to be in that category, and one patient in the Al-Hasa outbreak was believed to have infected seven others.

McGeer said it's theoretically possible that a super spreader is a factor in the Jeddah outbreak, but she thinks it unlikely that that would explain all the cases, because that would seem to require several super spreaders, not just one.

Research badly needed
One way to help figure out if the virus is changing is to get a MERS-CoV sample, sequence its genome, and compare it with earlier isolates. But McGeer said, "Nobody's seen any 2014 isolates."

Noting that cases were identified last week in Greece and Malaysia, she expressed a hope that isolates from those patients will be sequenced.

The CDC's Swerdlow said in response to a question, "We are working with our partners to obtain [MERS-CoV] samples for sequencing."

Price voiced what is probably the view of many observers of the MERS-CoV landscape: "We need to stop guessing, get all hands on deck (ie, international collaboration), and do a detailed outbreak investigation with case-control study, complemented by genetic sequencing data to understand what is happening. This should be doable right now."

[dothedd]

World Health Organization (Eastern Mediterranean Regional Office)

WHO vigilant on new Middle East Respiratory Syndrome developments

Cairo, 23 April, 2014 – The World Health Organization (WHO) is concerned about the rising number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in recent weeks, especially in the Kingdom of Saudi Arabia and the United Arab Emirates (UAE) and in particular that two significant outbreaks which occurred in health facilities.

“Approximately 75 percent of the recently reported cases are secondary cases, meaning that they are considered to have acquired the infection from another case through human-to-human transmission,” Dr. Ala Alwan, WHO Regional Director for the Eastern Mediterranean said. “The majority of these secondary cases have been infected within the healthcare setting and are mainly healthcare workers, although several patients are also considered to have been infected with MERS-CoV while in hospital for other reasons.”

Although the majority of the cases had either no or only minor symptoms, and most do not continue to spread the virus, WHO acknowledges that some critical information gaps remain to better understand the transmission of the virus as well as the route of infection. WHO is unaware at this point in time of the specific types of exposure in the health care facilities that have resulted in transmission of these infections, but this remains a concern.

Therefore, WHO has offered its assistance to mobilize international expertise to Saudi Arabia and UAE to investigate the current outbreaks in order to determine the transmission chain of this recent cluster and whether there is any evolving risk that may be associated with the current transmissibility pattern of the virus.

Since the emergence of MERS in April 2012, a total of 253 laboratory-confirmed cases of human infections with MERS have been reported to WHO, including 93 deaths. These cases have been reported in the Middle East (including Jordan, Kuwait, Oman, Qatar, Saudi Arabia and UAE); in Europe ( France, Germany, Greece, Italy and the United Kingdom of Great Britain and Northern Ireland); in North Africa (Tunisia); and in Asia (Malaysia and the Philippines). The source and mode of infection for the virus remain undetermined.

Several recent cases of people becoming infected in either Saudi Arabia or UAE and traveling to a third country have also been reported. Greece, Jordan, Malaysia, and Philippines each reported one such case. So far no further spread of the virus in those countries has been detected. Imported cases already occurred in the past that resulted in limited further human-to-human transmission in France and United Kingdom.

WHO urges all Member States to remain vigilant and enhance surveillance to detect any early sign that the virus has changed and has attained the possibilities of causing sustained person-to-person transmission. WHO expects that it is only through an enhanced coordinated effort the mystery and the risk to global health associated with the emergence of this virus can be unraveled.

[dothedd]

WHO office sounds alarm as MERS cases push higher
CIDRAP News | Apr 23, 2014


Against the backdrop of 33 more Middle East respiratory syndrome coronavirus (MERS-CoV) cases reported by Saudi Arabia—some in Mecca—and the United Arab Emirates (UAE), the World Health Organization (WHO) today raised concerns about the ongoing spike in cases, especially in healthcare settings, and offered to help the countries pull together a global team to help investigate and assess the risks.

The WHO aired the issues in a press release that its Eastern Mediterranean office (EMRO) in Cairo e-mailed to journalists. The statement came amid two separate announcements of cases from Saudi Arabia's health ministry—one reporting 11 new cases and the other reporting 13 new illnesses, two of them fatal, along with two other deaths. In addition, WHO headquarters in Geneva announced details about nine MERS-CoV cases that it received from the UAE on April 16, 18, and 21.

The statements from Saudi Arabia included details about the first cases reported in the holy city of Mecca, including one in a Turkish pilgrim.

WHO offers assistance
Ala Alwan, MD, EMRO's director, said in the statement that 75% of recently reported infections are secondary cases, considered to have been spread from other people. "The majority of these secondary cases have been infected within the healthcare setting and are mainly healthcare workers, although several patients are also considered to have been infected with MERS-CoV while in hospital for other reasons," he added.

Underscoring WHO EMRO's concerns about illness links to health settings, three of Saudi Arabia's MERS-CoV case-patients reported today are healthcare workers, two from Jeddah and one from Riyadh. Also, two of the UAE patients had hospital exposure: one while visiting a facility and the other a patient who had been hospitalized since late February for another medical condition.

Among other common threads in today's cases, 17 had underlying medical conditions, and 10 are listed as contacts of other confirmed cases. Most of the patients who had known contact with a lab-confirmed case-patient have no symptoms or only mild symptoms.

WHO EMRO said that though most of the cases involve asymptomatic or mild infections and don't spread the virus to others, key information gaps remain about the transmission of the virus and the route of infection. One of the unanswered questions is the type of exposure in healthcare settings that transmit the virus.

Therefore, the WHO is offering to gather international expertise to help the two countries probe the recent outbreaks to identify the transmission chain in the clusters and if the pattern signals any new risks.

The WHO also raised concerns about a fresh round of MERS-CoV infections in people who visited Saudi Arabia or the UAE, as recent cases were reported in Greece, Jordan, Malaysia, and the Philippines. It said that though no further spread of the virus has been linked to those cases, earlier imported cases in France and the United Kingdom resulted in limited human-to-human spread.

It urged nations to stay vigilant and enhance surveillance to detect any sign that the virus has changed in a way that makes it more transmissible among humans.

Saudi Arabia reports 24 cases
Saudi Arabia said today in its first statement (posted in English on the health ministry's web site) that four of the 11 case-patients reported today are from Riyadh, six are from Jeddah, and one is from Mecca. All 11 of the cases are residents of Saudi Arabia. Ten are adults, ranging in age from 24 to 81 years old. One is a 13-year-old Jeddah resident, a contact of a previous case, who is asymptomatic.

Of the 11 patients, eight are being treated in intensive care units (ICUs), two are listed in stable condition, and one is asymptomatic. Three of the patients are healthcare workers.

Later today the health ministry announced 13 more cases, according to a machine translation of a statement posted in Arabic. Five cases are reported from Riyadh, two from Jeddah, four from Mecca, one from Medina, and one from Jordan, which appears to be an imported case from Saudi Arabia.

The statement contained several details about the cases that haven't typically been included in past ministry statements, such as hospitalization locations and dates, which underlying medical conditions they have, and if they have pneumonia and are on respirators. It's not clear if the added details in the latest statement are the result of the country's recent change in health ministers. Earlier in the week Saudi Arabia reassigned its health minister and appointed labor minister Adel bin Mohammad Faqih as acting health minister.

One of the patients is a 65-year-old pilgrim from Turkey who is hospitalized in stable condition in Mecca.

Two deaths were reported among the 13 new cases: an 80-year-old man with several underlying medical conditions who died at a Riyadh hospital on Apr 22 and a 52-year-old who was hospitalized in Mecca and also died on Apr 22. Saudi Arabian officials also reported two other deaths in presumably previously confirmed cases, which include a 45-year-old health worker from Al-Kharj governorate who died on Apr 21 and a 29-year-old who died at King Fahd Hospital in Jeddah on Apr 22.

Five of the patients are hospitalized at a military hospital in Riyadh, one is at King Faisal Specialist Hospital in Jeddah, one is hospitalized in Medina, one at a security force hospital in Mecca, and three apparently at another hospital in Mecca.

Of the 13 cases, two patients died, three are on respirators, three are being treated in ICUs, four are stable, and one is asymptomatic. Hospitalization dates, listed for 10 of the patients, range from Mar 27 through Apr 21.

Patient ages range from 13 to 88, though most are middle-aged and older adults.

MERS sickens nine more in UAE
Details about the nine cases in the UAE were included in a statement today from the WHO. All of the patients are adults from Abu Dhabi, ranging in age from 28 to 73 years old. One is a 52-year-old woman who got sick after traveling to Jeddah in Saudi Arabia from Apr 5 through Apr 16, where she visited the hospital three times. One of the others is a 73-year-old woman who had been hospitalized since Feb 26 for another medical condition and was admitted to the ICU on Apr 14.

Six of the UAE cases, all reported to the WHO on Apr 16, had close contact with a lab-confirmed case that was reported on Apr 10. Three are women and three are men. Four had mild illnesses and two were asymptomatic. Only one of them had an underlying medical condition.

With the flurry of recent new cases and lack of clarity in some of the recent health ministry statements, the outbreak total is unclear. FluTrackers, an infectious disease news message board, maintains a running list of lab-confirmed MERS-CoV cases, along with an updated overall case count. However, it said today that some of the cases appear to have already been reported, such as that of a 52-year-old UAE woman reported today, and that as of today it will no longer track the overall count, though it will continue to provide daily case totals.

The WHO said today in the EMRO statement that it has received reports of 253 lab-confirmed cases, including 93 deaths. FluTrackers, in its last case count, said there were 364 cases reported by health ministries. Meanwhile, Saudi Arabia's health ministry said today that it has now recorded 285 infections from MERS-CoV, 83 of them fatal.

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"Vaccine
Available online 13 April 2014

Highlights:
* Emergence of MERS-CoV demonstrates the need for novel vaccine strategies against coronaviruses.
* Production of novel nanoparticle vaccine containing full spike protein of MERS-CoV and SARS-CoV.
* Higher titer neutralizing antibody produced in vaccinated mice.
* Vaccination in combination with a new adjuvant, Matrix M1, boosts neutralizing antibody titer.

Abstract:
Development of vaccination strategies for emerging pathogens are particularly challenging because of the sudden nature of the emergence of these viruses and the long process needed for traditional vaccine development. Therefore, there is a need for development of a rapid method of vaccine development that can respond to emerging pathogens in a short time frame.

The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and Middle East Respiratory Syndrome (MERS-CoV) in late 2012 demonstrate the importance of coronaviruses as emerging pathogens. The spike glycoproteins of coronaviruses reside on the surface of the virion and are responsible for virus entry. The spike glycoprotein is the major immunodominant antigen of coronaviruses and has proven to be an excellent target for vaccine designs that seek to block coronavirus entry and promote antibody targeting of infected cells.

Vaccination strategies for coronaviruses have involved live attenuated virus, recombinant viruses, non-replicative virus-like particles expressing coronavirus proteins or DNA plasmids expressing coronavirus genes. None of these strategies has progressed to an approved human coronavirus vaccine in the ten years since SARS-CoV emerged. Here we describe a novel method for generating MERS-CoV and SARS-CoV full-length spike nanoparticles, which in combination with adjuvants are able to produce high titer antibodies in mice."

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Novavax Appoints Dr. Cindy Oliver as Senior Vice President, Process Development Operations
04/07/14

Novavax Appoints Dr. Cindy Oliver as
Senior Vice President, Process Development Operations
Gaithersburg, MD (April 7, 2014) - Novavax, Inc. (Nasdaq: NVAX), a clinical-stage
biopharmaceutical company focused on the discovery, development and commercialization of
recombinant nanoparticle vaccines and adjuvants, today announced the appointment of Cynthia
N. Oliver, Ph.D. to the position of Senior Vice President, Process Development Operations,
effective April 8, 2014. Dr. Oliver will be responsible for all process development activities, with
a specific focus on the company’s RSV F-protein nanoparticle, seasonal influenza and pandemic
influenza vaccine candidates.

Dr. Oliver has been a consultant of Novavax since 2011 where her significant expertise and
experiences have helped the Company formulate and execute on critical process development
strategies. From 1993 until 2010, Dr. Oliver held a variety of positions, including Vice President,
Process Biochemistry and Formulation Sciences at Medimmune, Inc., with responsibilities that
included vaccines, proteins, monoclonal antibodies and small molecules, including the
commercial products Synagis® and FluMist®. Prior to MedImmune, she had similar
responsibilities at Merck Research Laboratories, and spent a number of years working at the
National Institutes of Health in the National Heart, Lung and Blood Institute. She earned her
doctorate from Johns Hopkins, her masters from University of Massachusetts, and her bachelor’s
degree from Connecticut College.

“At Novavax, successful process development is critical to the ongoing development of our
novel vaccines and it serves as the foundation upon which a consistent, GMP commercial
manufacturing process is built. Cindy’s extensive experience, industry knowledge and
managerial aptitude complement our ongoing efforts to bring our RSV, seasonal influenza and
pandemic influenza vaccine candidates to licensure,” said Stan Erck, President and CEO of
Novavax, Inc. “After working with us as a consultant for three years, I am delighted that Cindy
has agreed to join Novavax to lead our process development efforts.”

Dr. Oliver remarked, “Novavax’ progress and success in Phase 2 clinical trials evidences its
commitment to bringing important, and in the case of RSV, industry-leading vaccines to the
market. I have been delighted to consult with Novavax to this stage, and am equally delighted to head up our efforts to develop safe, high quality vaccines and state-of-the-art vaccine production.

Novavax’ approach to developing these and other, earlier-stage preclinical vaccine candidates,
has tremendous commercial potential, and I am honored to lead the process development
function that supports this exciting technology.”

About Novavax
Novavax, Inc. (Nasdaq: NVAX) is a clinical-stage biopharmaceutical company creating novel
vaccines and vaccine adjuvants to address a broad range of infectious diseases worldwide.

Using innovative proprietary recombinant protein nanoparticle vaccine technology, the company produces vaccine candidates to efficiently and effectively respond to both known and newly emergent diseases. Additional information about Novavax is available on the company’s
website, novavax.com.


Upcoming Events

Immunopotentiators in Modern Vaccines
Albufeira, Algarve, Portugal, Sao Rafael Atlantic Hotel
May 9, 2014, 10:00-10:30am
Presenter: Karin Lovgren

SESSION 8:
PLENARY
Moderator: Jim Brewer (University of Glasgow, Glsagow, Scotland, UK)

09.00-09.30
‘Adaptive immunity enhancing innate immunity’
Martin Bachmann (University of Oxford, Oxford, UK/Univeristy of Zurch Hospital, Zurich, Switzerland)

09.30-10.00
‘Induction of prophylactic or therapeutic protection against tumors using ISCOMATRIX adjuvant in mouse models of cancer’
Adriana Baz Morelli (CSL Limited, Melbourne, Australia)

10.00-10.30
‘Title to be confirmed’
Greg Glenn (Novavax Inc., Rockville, Maryland USA) or Swedish Group Novavax AB

10.30-10.50
Coffee Break

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Saudi Arabia reports pilgrim infected with MERS
Updated: Apr 24, 2014 12:24 PM EDT

By ABDULLAH AL-SHIHRI
Associated Press
RIYADH, Saudi Arabia (AP) - In the past 24 hours, Saudi Arabia has reported four new deaths from a Middle East virus related to SARS and 36 more cases of infection, including a Turkish pilgrim in Mecca.

Officials are struggling to alleviate concerns that the virus is spreading amid a spike in infections over the past several weeks. Many of the infections reported Wednesday and Thursday are health workers.

Prince Miteb, the son of ruler King Abdullah and the head of the Saudi National Guard, was quoted in newspapers Thursday saying that the king arrived in the eastern city of Jiddah sooner than usual in order to be with the people there, amid a rise in infections. The king traditionally spends his summers in Jiddah, where the seaside weather is cooler than in the capital.

"Every Saudi citizen is more valuable to the king than himself," the prince was quoted as saying in the state-backed al-Watan newspaper.

The Middle East respiratory syndrome, or MERS, belongs to a family of viruses known as coronaviruses that include both the common cold and SARS, or severe acute respiratory syndrome, which killed some 800 people in a global outbreak in 2003. MERS can cause symptoms such as fever, breathing problems, pneumonia and kidney failure.

The most recent deaths reported by the Saudi Health Ministry bring to 85 the number of people who have died in the kingdom from the virus that appeared in 2012. The kingdom has recorded a total of at least 297 confirmed cases.

There is no vaccine or treatment for the virus, and it is still unclear how it is transmitted.

The 65-year-old Turkish pilgrim is among six new cases reported in Mecca, where millions of Muslims from around the world descend year-round. That's raised concerns that the virus could spread among pilgrims.

The ministry said the youngest cases from the newest batch of infections are two 13 year olds, one in the city of Medina and another in Jiddah. In one other case, a 25-year-old Saudi male is being treated in Jordan, according to the Saudi Health Ministry.

The ministry reported the four latest Saudi deaths in separate statements: a 45-year-old male health worker in al-Kharj, a city about 50 miles (80 kilometers) outside the capital Riyadh; a 29-year-old male who contracted the virus "from the public" in Jiddah; a 72-year-old woman in Riyadh; and a 68-year-old man in Mecca.

On Monday, the king removed the country's health minister following the recent spike in MERS cases. The next day, acting Health Minister Adel Faqih toured a hospital in Jiddah and met with MERS patients while wearing gloves, a medical robe and face mask. An outbreak among health workers prompted authorities to shut down the emergency ward of that hospital for 48 hours earlier this month.



Read more: www.myfoxdc.com/story/25327497/saudi-arabia-reports-pilgrim-infected-with-mers#ixzz2zvmv1MY9
Follow us: @fox5newsdc on Twitter | myfoxdc on Facebook

[dothedd]

Last Updated Thursday, April 24, 2014 7:07PM EDT

TORONTO -- Countries should be on the lookout for cases of MERS in people returning from Middle Eastern countries affected by the virus, the World Health Organization said Thursday in an updated risk assessment of the new coronavirus.

The number of known infections has skyrocketed in recent days, with Saudi Arabia alone reporting 48 cases on Wednesday and Thursday. In the 20 months since the world became aware a new coronavirus was infecting people, there has not been a single month where the total cases from all affected countries was as high as that two-day tally.

In the past two weeks alone cases were exported to Greece, Malaysia, Jordan and the Philippines, the global health agency said, warning that the virus may pop up in various parts of the globe carried by people who have been to countries like Saudi Arabia and the United Arab Emirates

"It is very likely that cases will continue to be exported to other countries, through tourists, travellers, guest workers or pilgrims, who might have acquired the infection following an exposure to the animal or environmental source, or to other cases, in a hospital for instance," the risk assessment said.

The WHO noted that diagnosing cases rapidly may be a challenge because some have mild or atypical symptoms. The man detected in Greece, for instance, did not initially appear to have a respiratory infection. He had a protracted fever and diarrhea, but doctors were suspicious because he had travelled to Greece from Saudi Arabia. The man developed pneumonia while in hospital.

The risk assessment suggested that given the potential to initially miss MERS cases, health-care workers should apply infection control precautions consistently with all patients, all the time, regardless of their diagnosis.

The document said the WHO continues to recommend against border screening as a method of trying to detect incoming cases. As well, it recommends that governments not apply travel or trade restrictions against countries that are sources of MERS infections.

A senior official of the Public Health Agency of Canada said federal authorities are in regular communications with provincial and territorial counterparts about the situation and the possibility of imported cases of MERS or avian influenza in travellers.

Dr. Theresa Tam said since last September more than 3,000 people have been screened in Canada, but to date no cases of MERS have been found.

"The bottom line is that we've been ramped up for quite some time, not just on this bug but to deal with any emerging viruses," said Tam, who is the head of the Public Health Agency's health security infrastructure branch.

"Like Greece or France or Italy, it's possible to get a traveller for sure. And so the system is designed to try to pick that up."

France, Italy, Germany and Britain have also diagnosed MERS cases in people who travelled to the Middle East or flew from there to Europe for treatment. Those importations happened in 2012 and 2013.

The number of MERS cases has soared this month, fuelled in part by outbreaks in health-care settings in Jidda, Saudi Arabia, and Abu Dhabi, United Arab Emirates.

The WHO has confirmed 254 cases, but at this point its tally lags far behind the numbers reported by affected countries. The combined case count announced by countries has reached about 385 cases since the first known infections. The death toll to date is over 100.

More than 45 per cent of all MERS cases that have ever been diagnosed have been recorded this month. That enormous spike in cases is raising concerns about the virus, with experts wondering if it has changed to become more easily transmitted from person to person.

The WHO says three-quarters of the recent cases appear to be ones where the transmission was person to person, not from an animal or environmental source to a person.

In two cases, person-to-person-to-person spread has been suspected, the risk assessment said.

There have been no recent reports of scientists analyzing MERS viruses to see if they have changed. But on Thursday, German coronavirus expert Dr. Christian Drosten confirmed that he recently received a shipment of samples from Saudi Arabia and his laboratory has begun to sequence the material.

"Currently the sequences don't tell a lot. They look all the same," said Drosten, who is the head of virology at the University of Bonn.

He cautioned that the work has just begun, and only a small portion of the viruses have been sequenced, but said that what he has seen so far looks 100 per cent identical to viruses from earlier in the outbreak.

The WHO risk assessment said it appears that there is slightly more human-to-human spread than there has been in the past. But whether that is because the virus had become more transmissible or is due to a combination of outbreaks in hospitals and more aggressive searching for cases can't be determined at this point.

The global health agency suggested that people who are likely at high risk of becoming seriously sick if they contract the virus should take precautions when visiting farms, barn areas or markets where camels are present.

Camels have been heavily implicated in the MERS story, though it is still not clear how people are catching the virus from the animals.

The WHO said people at high risk should think about avoiding camels, and refraining from drinking raw camel milk or food that may have been contaminated with animal secretions until it has been properly washed, peeled or cooked.

People considered to be at high risk of becoming seriously ill with MERS include those with diabetes, chronic lung disease, kidney failure or who are immunocompromised.


Read more: kitchener.ctvnews.ca/canada-on-lookout-for-mers-as-cases-spread-worldwide-1.1791386#ixzz2zwJSAZ16

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Four people die of coronavirus in Saudi Arabia 

25/04/2014 | 11:22 PM | Gulf News

RIYADH, April 25 (KUNA) -- Four persons died of coronavirus and 10 others are infected with the virus and hospitalized in Jeddah, Makkah and Riyadh, the Health Ministry said Friday.
It said in a statement that an 81-year-old Palestinian man was diabetic and has unstable blood pressure history died of the virus.

A female from Bangladesh, who is 40 years old, also died after being infected with the virus, it said, in addition to a 30-year-old Saudi citizen and a 64-year-old diabetic Palestinian expatriate.
Other coronavirus cases were hospitalized in Riyadh, Makkah and Jeddah, said the ministry. The patients, some of them Asian nurses, were closely monitored .

Minister of Health Adel Faqih said renowned experts would arrive in Riyadh next Tuesday to provide advice on how to deal with coronavirus. 

www.kuna.net.kw/ArticleDetails.aspx?id=2374089&Language=en