Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh
Identifieur interne : 000829 ( Pmc/Corpus ); précédent : 000828; suivant : 000830Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh
Auteurs : Ziad A. Memish ; Abdullah Assiri ; Rafaat Alhakeem ; Saber Yezli ; Malak Almasri ; Alimuddin ZumlaSource :
- International Journal of Infectious Diseases [ 1201-9712 ] ; 2014.
Url:
DOI: 10.1016/j.ijid.2014.05.001
PubMed: 24818990
PubMed Central: 7128856
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PMC:7128856Le document en format XML
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Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh</title>
<author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name>
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<author><name sortKey="Assiri, Abdullah" sort="Assiri, Abdullah" uniqKey="Assiri A" first="Abdullah" last="Assiri">Abdullah Assiri</name>
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<author><name sortKey="Alhakeem, Rafaat" sort="Alhakeem, Rafaat" uniqKey="Alhakeem R" first="Rafaat" last="Alhakeem">Rafaat Alhakeem</name>
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<author><name sortKey="Yezli, Saber" sort="Yezli, Saber" uniqKey="Yezli S" first="Saber" last="Yezli">Saber Yezli</name>
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<author><name sortKey="Almasri, Malak" sort="Almasri, Malak" uniqKey="Almasri M" first="Malak" last="Almasri">Malak Almasri</name>
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<author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name>
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<affiliation><nlm:aff id="aff0025">Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2<sup>nd</sup>
Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh</title>
<author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name>
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<author><name sortKey="Assiri, Abdullah" sort="Assiri, Abdullah" uniqKey="Assiri A" first="Abdullah" last="Assiri">Abdullah Assiri</name>
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<author><name sortKey="Yezli, Saber" sort="Yezli, Saber" uniqKey="Yezli S" first="Saber" last="Yezli">Saber Yezli</name>
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</affiliation>
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<author><name sortKey="Almasri, Malak" sort="Almasri, Malak" uniqKey="Almasri M" first="Malak" last="Almasri">Malak Almasri</name>
<affiliation><nlm:aff id="aff0005">Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name>
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<affiliation><nlm:aff id="aff0025">Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom</nlm:aff>
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<pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Int. J. Infect. Dis</journal-id>
<journal-title-group><journal-title>International Journal of Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">1201-9712</issn>
<issn pub-type="epub">1878-3511</issn>
<publisher><publisher-name>Published by Elsevier Ltd.</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24818990</article-id>
<article-id pub-id-type="pmc">7128856</article-id>
<article-id pub-id-type="publisher-id">S1201-9712(14)01491-X</article-id>
<article-id pub-id-type="doi">10.1016/j.ijid.2014.05.001</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Middle East Respiratory Syndrome Corona virus, MERS-CoV. Conclusions from the 2<sup>nd</sup>
Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Memish</surname>
<given-names>Ziad A.</given-names>
</name>
<email>zmemish@yahoo.com</email>
<xref rid="aff0005" ref-type="aff">a</xref>
<xref rid="cor0005" ref-type="corresp">⁎</xref>
</contrib>
<contrib contrib-type="author" id="aut0010"><name><surname>Assiri</surname>
<given-names>Abdullah</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="aut0015"><name><surname>Alhakeem</surname>
<given-names>Rafaat</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="aut0020"><name><surname>Yezli</surname>
<given-names>Saber</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="aut0025"><name><surname>Almasri</surname>
<given-names>Malak</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
</contrib>
<contrib contrib-type="author" id="aut0030"><name><surname>Zumla</surname>
<given-names>Alimuddin</given-names>
</name>
<xref rid="aff0005" ref-type="aff">a</xref>
<xref rid="aff0025" ref-type="aff">b</xref>
</contrib>
</contrib-group>
<aff id="aff0005"><label>a</label>
Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia</aff>
<aff id="aff0025"><label>b</label>
Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom</aff>
<contrib-group><contrib contrib-type="author" id="aut0035"><name><surname>Al-Tawfiq</surname>
<given-names>Jaffar A.</given-names>
</name>
</contrib>
</contrib-group>
<aff id="aff0010">Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia and Indiana University School of Medicine, Indianapolis, IN (USA)</aff>
<contrib-group><contrib contrib-type="author" id="aut0040"><name><surname>Drosten</surname>
<given-names>Christian</given-names>
</name>
</contrib>
</contrib-group>
<aff id="aff0015">Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany</aff>
<contrib-group><contrib contrib-type="author" id="aut0045"><name><surname>Albarrak</surname>
<given-names>Ali</given-names>
</name>
</contrib>
</contrib-group>
<aff id="aff0020">Saudi CDC, Ministry of Health, Riyadh, KSA</aff>
<contrib-group><contrib contrib-type="author" id="aut0050"><name><surname>Petersen</surname>
<given-names>Eskild</given-names>
</name>
</contrib>
</contrib-group>
<aff id="aff0030">Institute of Clinical Medicine, Departments of Infectious Diseases and Clinical Microbiology, Aarhus University Hospital, Denmark</aff>
<author-notes><corresp id="cor0005"><label>⁎</label>
Corresponding author. Deputy Minister for Public Health, and Director WHO Collaborating Center for Mass Gathering Medicine Ministry of Health, and Professor, Al-Faisal University, Riyadh 11176, KSA. <email>zmemish@yahoo.com</email>
</corresp>
</author-notes>
<pub-date pub-type="pmc-release"><day>10</day>
<month>5</month>
<year>2014</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>7</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>10</day>
<month>5</month>
<year>2014</year>
</pub-date>
<volume>24</volume>
<fpage>51</fpage>
<lpage>53</lpage>
<permissions><copyright-statement>Copyright © 2014 Published by Elsevier Ltd.</copyright-statement>
<copyright-year>2014</copyright-year>
<copyright-holder></copyright-holder>
<license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
</permissions>
</article-meta>
</front>
<body><p id="par0005">The 2<sup>nd</sup>
Scientific Advisory Board Meeting of the Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia, met April 28 – 29 in Riyadh to discuss risk of infectious diseases and research and surveillance during Hajj. Due to the on-going outbreak of MERS-CoV and especially the recent increase in case detection in Jeddah, (138 MERS cases were reported from Jeddah between 11 to 26 April 2014), the agenda for the second day was focused on MERS-CoV, both in relation to the risk it presents for the forthcoming Umrah during Ramadan and the Hajj, but also in the Kingdom of Saudi Arabia and the Middle East in general. The Ministry of Health used the opportunity to ask the Scientific Advisory Board to review the MERS-CoV situation globally with specific attention to MERS in the country and review case definition, infection control guidelines and risk assessment to nationals, residents, health care workers, family contacts, camel owners, and travelers to KSA, and the future control.</p>
<sec id="sec0005"><label>1</label>
<title>Background</title>
<p id="par0010">MERS-CoV is a new Coronavirus initially isolated from a patient from Saudi Arabia in 2012.<xref rid="bib0005" ref-type="bibr"><sup>1</sup>
</xref>
Phylogenetic analyses showed that the virus was close to the SARS Coronavirus, and the epidemiology and clinical presentation of infection with the two viruses has been compared.<xref rid="bib0010" ref-type="bibr"><sup>2</sup>
</xref>
</p>
<p id="par0015">As of May 1<sup>st</sup>
2014, the total number of laboratory confirmed MERS-CoV infections reported were 371, including 107 deaths.<xref rid="bib0015" ref-type="bibr"><sup>3</sup>
</xref>
Countries in the Middle East reporting cases are KSA, Qatar, Jordan, Oman, Kuwait and United Arab Emirates. Secondary cases has been reported in several European (United Kingdom, France, Germany, Italy, Greece), Asian (Malaysia and Phillipines) and Middle East Area (MEA) (Egypt) countries, and the potential for a pandemic as for SARS has been discussed.<xref rid="bib0020" ref-type="bibr">4</xref>
, <xref rid="bib0025" ref-type="bibr">5</xref>
, The cases outside the Arabian peninsula and Middle East have either been infected in the Middle East or been in close contact with a MERS-CoV cases. Only secondary cases linked to index cases infected in the Middle East have been reported and no further human to human transmission has occurred. The US Centers for Diseases Control and Prevention (CDC) announced on Friday May 2<sup>nd</sup>
, 2014, the first case of MERS-CoV in a travelerto the United States from Riyadh, KSA.<xref rid="bib0030" ref-type="bibr"><sup>6</sup>
</xref>
</p>
</sec>
<sec id="sec0010"><label>2</label>
<title>The Virus</title>
<p id="par0020">Corona virus is found in all mammalian and avian species. The origin of the MERS-CoV has been much discussed and bats were early mentioned due to close phylogeny between certain bat CoV's and MERS-CoV.<xref rid="bib0005" ref-type="bibr"><sup>1</sup>
</xref>
The phylogeny of Coronaviruses has been extensively reviewed.<xref rid="bib0035" ref-type="bibr"><sup>7</sup>
</xref>
Recently three entire MERS-CoV genomes from Jeddah outbreak have been sequenced and the data was presented at the Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia, April 28 – 29 (Drosten C unpublished). The overall finding was announced the 26<sup>th</sup>
April,<xref rid="bib0040" ref-type="bibr"><sup>8</sup>
</xref>
and the conclusion is that overall the virus is stable and there is no sign of mutations indicating an adaptation to cause sustained human to human transmission.</p>
</sec>
<sec id="sec0015"><label>3</label>
<title>Animal reservoirs</title>
<p id="par0025">Dromedary camels have convincingly been shown to harbor the virus and be able to shed MERS CoV in high numbers in secretions from the upper respiratory tract.<xref rid="bib0045" ref-type="bibr"><sup>9</sup>
</xref>
Studies of previous samples from 2005 found neutralizing antibodies to MERS-CoV in dromedars in Dubai, indicating that the virus is not new on the Arabian peninsula.<xref rid="bib0050" ref-type="bibr"><sup>10</sup>
</xref>
It cannot be excluded that other animal reservoirs exist, but the fact that the MERS-CoV cases primarily is reported from the Middle East and in particular from the Arabian peninsula, suggest that dromedars and camels in general are the main animal reservoir and primary cases occur in areas where camels are an important part of life. Unpasteurized camel milk is a possible route of transmission, but so far there is no data on excreting of MERS-CoV into camel milk.</p>
</sec>
<sec id="sec0020"><label>4</label>
<title>Human transmission</title>
<p id="par0030">The Scientific Advisory Board Meeting of the Global Center for Mass Gatherings Medicine discussed the reported cases and the risk factors for infection. The questions addressed were: 1) what were the reasons for the increased case detection rates in March and April as reported from Jeddah? 2) Was this due to seasonality or increased virulence? 3) Had the human-to-human transmission pattern changed and the basic reproductive rate increased? 4) Were optimal infection control procedures followed? 5) Had the clinical presentation of MERS-CoV changed? 6) What changes were required in current recommendations for infection control practices in the community or in hospitals? 7) What precautions should those in contact with camels follow? 8) What advice should be given to parents and schools? 9) What advice should be given to travelers to the Middle East and should travel restrictions be in place? 10) What options were available for treatment of MERS? 11) What were the research priorities?</p>
<p id="par0035">It is clear from previous reports that nosocomial infection is important.<xref rid="bib0055" ref-type="bibr">11</xref>
, <xref rid="bib0060" ref-type="bibr">12</xref>
, <xref rid="bib0065" ref-type="bibr">13</xref>
, <xref rid="bib0070" ref-type="bibr">14</xref>
Household transmission is another important risk.<xref rid="bib0075" ref-type="bibr"><sup>15</sup>
</xref>
</p>
</sec>
<sec id="sec0025"><label>5</label>
<title>Management of inpatients with MERS</title>
<p id="par0040">Once in hospital with proved MERS-CoV treatment options are limited and patients are most often in intensive care with respiratory failure and may have multi-organ impairment especially renal failure.<xref rid="bib0080" ref-type="bibr"><sup>16</sup>
</xref>
It has been suggested looking at data from SARS-CoV that Ribavirin and Interferon beta or lopinavir combined with ritonavir may be used,<xref rid="bib0085" ref-type="bibr"><sup>17</sup>
</xref>
but the experience so far is limited.<xref rid="bib0090" ref-type="bibr"><sup>18</sup>
</xref>
The use of hyperimmune plasma from patients recovering from MERS-CoV may in theory also be an effective treatment as has been shown for influenza.<xref rid="bib0095" ref-type="bibr"><sup>19</sup>
</xref>
</p>
</sec>
<sec id="sec0030"><label>6</label>
<title>Conclusions</title>
<p id="par0045"><list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>1.</label>
<p id="par0050">Sequencing of MERS-CoV isolates from Jeddah patients the virus seems stable, showing no signs so far of mutations to indicate an adaption to humans with increased risk of human to human infections.</p>
</list-item>
<list-item id="lsti0010"><label>2.</label>
<p id="par0055">There is accumulating evidence for an animal reservoir in dromedary camels. Transmission is thought to be due to close physical contact or due to consumption of camel products.</p>
</list-item>
<list-item id="lsti0015"><label>3.</label>
<p id="par0060">The epidemiology since the virus was first found in 2012 is compatible with multiple introductions into humans from the animal reservoir, with no long-term sustained human-to-human transmission.</p>
</list-item>
<list-item id="lsti0020"><label>4.</label>
<p id="par0065">There is no human reservoir of cases with few or no symptoms.</p>
</list-item>
<list-item id="lsti0030"><label>5.</label>
<p id="par0075">The basic reproductive rate has been estimated to range below 1. Preliminary data from contact studies suggest a considerably lower rate below 0.5, suggesting that the virus has no pandemic potential. Special situations such as hospitalization with breaches in infection control practice can however cause local outbreaks with short transmission chains.</p>
</list-item>
<list-item id="lsti0035"><label>6.</label>
<p id="par0080">Nosocomial infection is an important risk factor for human to human transmission. Thus infection prevention and control measures are crucial to prevent the possible spread of MERS-CoV within health care facilities. Hospital infection control procedures needs to be emphazised and enforced. The Jeddah outbreak showed that it is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. It is important that health-care workers apply standard precautions consistently with all patients irrespective of the diagnosis. Droplet precautions should be undertaken when providing care to patients with symptoms of respiratory tract infection. Contact precautions including eye protection should be added when caring for suspected or confirmed cases of MERS-CoV infection. Airborne precautions should be taken when performing aerosol generating procedures</p>
</list-item>
<list-item id="lsti0045"><label>7.</label>
<p id="par0090">In asymptomatic cases RT-PCR testing is not recommended. Asymptomatic cases should be recorded and tested by serology after 3 weeks from exposure, unless symptoms develop.</p>
</list-item>
<list-item id="lsti0065"><label>8.</label>
<p id="par0110">Awareness of MERS-CoV is important in countries where camels and dromedars are a common livestock.</p>
</list-item>
<list-item id="lsti0050"><label>9.</label>
<p id="par0095">The importance of educational campaigns for educating health care workers, the general public, family contacts and travelers to the Middle East was emphasized. General hygiene measures such as regular hand washing, antiseptic before and after handling animals Owners of camels and dromedars should use gloves and mask when handling ill animals.</p>
</list-item>
<list-item id="lsti0055"><label>10.</label>
<p id="par0100">There is no evidence that camel's milk tested positive for MERS, however, milk has the potential of transmitting other infections. Camel milk should be boiled before consumption. Unpasteurised milk should not be consumed</p>
</list-item>
<list-item id="lsti0060"><label>11.</label>
<p id="par0105">There was no grounds for preventing children attending schools and closing schools</p>
</list-item>
</list>
</p>
</sec>
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