Posted on 01ST JUL 2018
tagged MERS-CoV, Saudi Arabia

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Vaccine trial phase I
[2] Saudi Arabia - WHO update, 12 Jan - 31 May 2018

[1] Vaccine trial phase I
Date: Wed 27 Jun 2018 08:00 AM
Source: Business Insider (Company Press Release) [edited]

MERS Vaccine Generates High Levels of Antibodies and Induces Broad-based T Cell Responses in Phase 1 StudyPhase 1/2 vaccine trial against the Middle East Respiratory Syndrome (MERS) will...

Inovio Pharmaceuticals, Inc. today [Wed 27 Jun 2018] announced positive Phase 1 results of its collaborative vaccine study with INO-4700 (GLS-5300) against MERS (Middle East Respiratory Syndrome). Results for INO-4700, which is being co-developed by Inovio and GeneOne Life Science Inc. (KSE:011000), showed that the drug was well-tolerated and demonstrated overall high levels of antibody responses in roughly 95 percent of subjects, while also generating broad-based T cell responses in nearly 90 percent of study participants.

The Phase 1, open-label, dose-escalation MERS vaccine trial, in partnership with the Walter Reed Army Institute of Research in Maryland, displayed antibody responses by ELISA in 94 percent of subjects at week 14 (2 weeks post-3rd dose). Additionally, there were no statistically significant dose-dependent differences in antibody response rates (91 percent, 95 percent, and 95 percent at doses of 0.67, 2, and 6 mg, respectively). Durable antibody responses to INO-4700 were also maintained through 60 weeks following dosing. Dr. Joel Maslow, GeneOne's Chief Medical Officer, presented the data [Tue 26 Jun 2018] this week in Seoul, Korea at the WHO-IVI Joint Symposium for MERS-CoV Vaccine Development.

Dr. J. Joseph Kim, Inovio President and CEO, said, "Inovio is utilizing our versatile immunotherapy and vaccine platform to target and develop the most advanced preventive vaccine for MERS, a virulent viral infection with no medical countermeasure. This trial further demonstrates Inovio's commitment to fighting emerging viral threats while also continuing to validate consistent high levels of both immune and antibody responses across our infectious disease platform. We look forward to continuing this development in a partnership with GeneOne and CEPI for developing novel therapies for MERS."

In April 2018, Inovio was awarded USD 56 million to develop a MERS vaccine through Phase 2 by The Coalition for Epidemic Preparedness Innovations (CEPI). The shared goal of Inovio and CEPI is for the MERS vaccine to be available for stockpile as soon as possible for emergency use. The CEPI funding also included support for Inovio's vaccine against the Lassa virus.

In collaboration with GeneOne Life Science, Inovio plans to begin a Phase 1/2 study for MERS in the 3rd quarter of this year [2018]. The study will be conducted by GeneOne Life Science in Korea and fully funded by a USD 34 million grant from the Samsung Foundation through the International Vaccine Institute.

In preclinical testing, INO-4700 induced 100 percent protection from a live virus challenge in a rhesus macaque non-human primate study. Inovio and its collaborators evaluated its MERS vaccine in mice, camels as well as non-human primates. As published in Science Translational Medicine, the vaccine induced robust immune responses in all 3 species. In monkeys, all vaccinated animals in the study were protected from symptoms of MERS when challenged with a live MERS virus.

Middle East Respiratory Syndrome is caused by a coronavirus that is related to the virus which causes severe acute respiratory syndrome (SARS). While the SARS coronavirus infected and caused illness in more than 8000 people worldwide, the disease was short-lived between 2002 and 2004 and had a case fatality rate of about 10 percent. Since the MERS-CoV was 1st identified in Saudi Arabia in 2012, as of May 2018 the World Health Organization indicates that laboratory-confirmed MERS cases have been reported for 2220 people worldwide, with 790 deaths, for a case fatality rate of 36 percent. Local occasional transmission is still ongoing, primarily in Saudi Arabia where a hospital outbreak occurred earlier this year [2018]. Highlighting the global concern for MERS, in the summer of 2015 a single business person returned to South Korea from Saudi Arabia and was the index case for a South Korea epidemic in 17 hospitals around the country. That epidemic was comprised of 186 confirmed cases with a 20 percent case fatality rate.

Communicated by:

[Thanks to ProMED-mail Rapporteur Mary Marshall for pointing us in the direction of this announcement. We usually do not post on phase I vaccine trials, but given the prolonged persistence of MERS-CoV activity in the Middle East, and the lack of adequate preventive measures and persistent high case fatality rate, it makes sense for us to share this information with our subscribers. We await further news on continued studies on this promising vaccine. - Mod.MPP]

[2] Saudi Arabia - WHO update, 12 Jan - 31 May 2018
Date: Mon 18 Jun 2018
Source: WHO Emergencies preparedness, response, Disease Outbreak News [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia [18 Jun 2018]
Between [12 Jan 2018] through 31 May 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 75 laboratory confirmed cases of Middle East respiratory syndrome coronavirus (MERS_CoV), including 23 deaths.

Details of the cases
Among these 75 cases, 21 cases were part of 4 distinct clusters (2 health care and 2 household clusters). The details of these clusters are described below, followed by a table listing all 75 laboratory confirmed cases reported to WHO during this time period:

Cluster 1: From [2 through 4 Feb 2018], a private hospital in Hafer Albatin Region reported a cluster of 3 health care workers in addition to the suspected index case (4 cases in total).

Cluster 2: From [25 Feb 2018 through 7 Mar 2018], a hospital in Riyadh reported 6 cases, including the suspected index. No health care workers were infected.

Cluster 3: From [8 through 24 Mar 2018], a household cluster of 3 cases (index case and 2 secondary cases) was reported in Jeddah. No health care workers were infected.

Cluster 4: From [23 through 31 May 2018], a household cluster was reported from Najran region with 8 cases including the suspected index case. This cluster is still under investigation at the time of writing. As of 31 May [2018], no health care workers have been infected and the source of infection is believed to be camels at the initial patient's home.

[A spreadsheet with details on the 75 cases mentioned in this report can be found at the source URL and downloaded by the link labeled MERSCoVCasesSaudiArabiaJanMay2018.pdf. - Mod.MPP]

As of 31 May [2018], the total global number of laboratory-confirmed cases of MERS-CoV reported since 2012 is 2220, including 1844 cases that have been reported from the Kingdom of Saudi Arabia. Among these cases, 790 MERS-CoV associated deaths have occurred since September 2012.

The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment
Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because, like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Community and household awareness of MERS and MERS prevention measures in the home may reduce household transmission and prevent community clusters.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, in addition to avoiding close contact with suspected or confirmed human cases of the disease, people with these conditions should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be or potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[According to the above report, there have been a total of 75 newly confirmed cases of MERS-CoV infection reported by Saudi Arabia during the period 12 Jan 2018 through 31 May 2018. The total number of MERS-CoV infections reported to WHO since September 2012 is now 2220 of which 1844 of these cases (83.1 percent) were reported by Saudi Arabia. A total of 790 deaths attributable to MERS-CoV infection were reported bringing the reported case fatality rate to 35.6 percent).

The accompanying spreadsheet details information on the 75 newly confirmed cases reported from Saudi Arabia. Cases were reported from at least 10 different regions of the country. Notable in these reports are the reduced number of nosocomial outbreaks/clusters than in previous years. That being said, 75 cases in a 5-month period is indicative of continued transmission of the MERS-CoV endemically in Saudi Arabia.

I have spent time going through the line listing of the 75 cases reported by WHO during this period and trying to reconcile this line listing with my own line listing drawn from information available on the Saudi MOH MERS webpages and information posted on ProMED-mail submitted directly by the Saudi MOH during this period their website is undergoing major revisions. Comparing the 2 line listings, there were significant discrepancies in reported cases I was unable to reconcile. The WHO line listing has 75 newly confirmed cases of MERS-CoV infection reported during this period, whereas my line listing had only 70 newly reported cases. There were 8 newly confirmed cases on the WHO list that had not been reported through the MOH website, and an additional 3 cases I had on my line listing that were not reported on the WHO line listing.... the net sum of which adds up to 75 newly confirmed cases of MERS-CoV infection during the period 12 Jan 2018 to 31 May 2018.

A better summation would be to state that there is continued MERS-CoV activity in Saudi Arabia during this period, including 4 clusters - 2 hospital based clusters and 2 household based clusters. One of the household based clusters was still ongoing according to the last report we received by the Saudi MOH on 2 Jun 2018.

The HealthMap/ProMED map of Saudi Arabia can be found at: http://healthmap/promed/p/131. - Mod.MPP]

See Also
MERS-CoV (21): EMRO/WHO update May 2018 20180612.5852927
MERS-CoV (20): Saudi Arabia (NJ), susp family cluster 20180602.5835120
MERS-CoV (19): Saudi Arabia (NJ) household cluster conf. 20180531.5830431
MERS-CoV (18): Saudi Arabia (NJ) susp. family cluster, RFI 20180530.5829389
MERS-CoV (17): UAE (Abu Dhabi), WHO 20180528.5824390
MERS-CoV (16): UAE (AZ), RFI 20180528.5823719
MERS-CoV (15): Saudi Arabia, WHO 20180525.5801103
MERS-CoV (14): Israel, animal reservoir, camelids 20180506.5787312
MERS-CoV (13): Saudi Arabia, new cases, superspreader 20180418.5754131
MERS-CoV (12): Saudi Arabia 20180402.5724114
MERS-CoV (11): Saudi Arabia 20180322.5702309
MERS-CoV (10): Oman, Saudi Arabia, WHO 20180315.5690014
MERS-CoV (09): Saudi Arabia, WHO 20180308.5671037
MERS-CoV (08): Saudi Arabia, RFI 20180214.5623644
MERS-CoV (07): Saudi Arabia 20180128.5590493
MERS-CoV (06): Saudi Arabia, WHO 20180126.5587442
MERS-CoV (05): Saudi Arabia 20180124.5581936
MERS-CoV (04): Saudi Arabia (RI) genomic evidence of camel role in transmission 20180116.5564064
MERS-CoV (03): Saudi Arabia, new cases, research 20180112.5556427
MERS-CoV (02): Saudi Arabia 20180109.5548385
MERS-CoV (01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman) 20180102.5532148
MERS-CoV (77): Saudi Arabia, camels, human, epidemiology, assessment 20171222.5520561
MERS-CoV (01): Saudi Arabia (QS,RI,MD), RFI 20170105.4744802
MERS-CoV (123): Saudi Arabia (MK, AS) new cases 20161231.4734758
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188
MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383
MERS-CoV (69): Saudi Arabia, new case, RFI 20141230.306305
MERS-CoV (01): Bangladesh, KSA, Algeria, UAE, Iran, WHO, RFI 20140616.2541707
MERS-CoV - Eastern Mediterranean (82): anim res, camel, seroepidemiology 20140613.2537848
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean: Saudi Arabia, new case, RFI 20130518.1721601
Novel coronavirus - Eastern Mediterranean (29): MERS-CoV, ICTV nomenclature 20130516.1717833
Novel coronavirus - Eastern Mediterranean: bat reservoir 20130122.1508656
Novel coronavirus - Eastern Mediterranean (06): comments 20121225.1468821
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733