MERS-COV (29): QATAR, ANIMAL RESERVOIR, CAMELS

Posted on 28TH MAY 2017
tagged MERS-CoV, QATAR

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International Society for Infectious Diseases
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Date: Wed 24 May 2017
Source: State of Qatar, Ministry of Public Health - News [edited]
https://www.moph.gov.qa/news/ministry-announces-new-mers-cov-case?backAr...

Ministry of Public Health (MOPH) has announced that a new Middle East Respiratory Syndrome Corona Virus (MERS-CoV) case has been confirmed for a 29-years-old, resident in Qatar, marking the 3rd MERS-CoV case to be confirmed in the country this year [2017] and bringing the cumulative number of confirmed MERS-CoV cases since 2012 to 21 cases among whom 7 have died.

The patient is a camel worker and had complaints of fever and dry cough for several days. He sought medical attention in Hamad General Hospital where an X-Ray investigation suggested a severe pneumonia. Consequently and as he reported an occupational frequent contact with camels, further samples were withdrawn from the patient. He ultimately tested positive for MERS-CoV according to Hamad Medical Corporation laboratories.

Despite his stable condition, the patient was admitted to hospital; in consistence with the national infection prevention and control protocol for confirmed and suspected MERS-CoV cases to ensure the appropriate medical attention. However, neither a history of contact with similar cases nor a recent travel outside the country was reported for the patient who has no comorbidities.

Once the case has been confirmed, the rapid response team of the Health Protection and Communicable disease Control (HP & CDC) department at the MOPH, accompanied with the team from Animal Health Department, Ministry of Municipality and Environment, have started a field investigation to assess the possible source of the infection and to verify whether any of the patient contacts has suspected symptoms according to the WHO standard case definition. Consequently, all traced contacts will be monitored over a period of 2 weeks, while those who develop suspected symptoms will then be subjected to confirmatory laboratory investigation.

The Ministry of Public Health advices citizens and residents, in particular those with comorbidities or low immunity, to abide to cough etiquette and handwashing with soap and water thoroughly and avoid unnecessary contact with sick animals.

MOPH proclaimed that Health Protection & CDC Hotlines 66740948 & 66740951 are accessible 24/7 to respond to any notification or enquiry related to infectious diseases.

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[The above press release mentioned the participation of animal health experts in the investigation of the described case. Information on their observations and findings, including results of laboratory tests (in case animal samples were taken), will be appreciated.

Qatar officially notified the OIE about its 1st event of MERS-CoV in camels, as an emerging disease, on 28 Nov 2013. The start of the event was, reportedly, dated 14 Oct 2013. The 'affected population' was kept on a "small farm with 14 camels, one sheep, one pigeon cage and some chicken" in Al-Shahanya, Ar Rayyan district. The diagnostic laboratory, given as "the Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), the Netherlands (OIE Reference Laboratory)", established the diagnosis of MERS-CoV in camels by PCR, on 26 Nov 2013. The report included the following epidemiological comment: "The health authority in Qatar notified the presence of a confirmed human MERS-CoV case. A joint team from both health and veterinary authorities was sent to the patient farm to investigate the health status of animals and the contact person. A farm worker proved to be positive for MERS-CoV and samples were collected from the 14 existing camels in addition to one sheep, some pigeons and chickens and some environmental samples (water, soil, animal food and grass) and all were sent to the Netherlands for testing. All animals were kept under observation and quarantine and all were apparently healthy". The above immediate notification was followed by 3 follow-up reports (29 Dec 2013, 22 Apr 2014 and 09 Jun 2014).

Follow-up report No 1, submitted a month later, namely on 29 Dec 2013, informed: "There are no new outbreaks in this report". The report, however, included the following epidemiological comments: "The samples from the same herd tested, using the same technique were negative and this may show that MERS-CoV infection in camels is a self-limiting disease. The planned massive survey for MERS-CoV in animals is under implementation and the same herd is under systematic retesting. Follow-up reports will be submitted when there will be new data".

Follow-up report No 2, submitted 22 Apr 2014, addressed "A single barn of 26 camels of different ages" in the same location (Al-Shahanyain), Qatar. The diagnostic laboratory was named as "Department of Viroscience, Erasmus Medical Center, Rotterdam (The Netherlands) (Foreign laboratory)"; the tests were performed on 19 Apr 2014, applying PCR and virus isolation, both positive. The report included the following epidemiological comments: "During an existing survey (pilot phase of the survey), nasal swabs were collected from an 8-month-old camel among healthy dromedary camels. The sample was inoculated on Vero cells and cytopathic changes were observed in cells at 48h post-infection. Human hepatoma cells (Huh-7 cells) were inoculated with MERS-CoV to further functionally characterize this viral isolate. After 2 days, virus-induced cytopathic effects were observed in the inoculated cell cultures. Virus production in Huh-7 cells was blocked by pre-incubating MERS-CoV with a 1/200 dilution of serum from MERS-CoV antibody positive camels. Conclusion: these data demonstrate that the MERS-CoV obtained from a dromedary camel is able to replicate in human cells and uses DPP4 as entry receptor, similar as isolates obtained from MERS patients".

Follow-up report No 3, submitted 9 Jun 2014, involved 3 barns with a total number of 12 camels of different ages, similarly in Al-Shahanya. Of the 12 susceptible camels, there were 5 "cases", indicated as an apparent morbidity rate of 41.67 percent. The diagnostic laboratory was "Erasmus Medical Center (Rotterdam) and National Institute for Public Health and the Environment (Bilthoven), The Netherlands (Foreign laboratory)", which applied SNT. This report included the following epidemiological comment: "Milk was collected according to local customs; cria's (dromedary calves) were not weaned after delivery but kept at the farm in paddocks adjacent to their dams throughout lactation. Dams were reunited with their cria to trigger milk production. Once milk production was initiated, the milk samples were collected by the camel owner or caretaker without specific hygienic precautions". The named follow-up report No 3 was the last report of MERS-CoV in camels submitted so far by Qatar to the OIE. It included the statement "continuing". No additional MERS-CoV reports from Qatar have become available since June 2014.

According to WAHID's archive data, the summary of the event since its start, as of June 2014, was:
Total outbreaks = 3 (Submitted)
Species/ Susceptible/ Cases/ Deaths/ Destroyed/ Slaughtered
Camelidae/ 52/ 9/ 0/ 0/ 0
(see at http://www.oie.int/wahis_2/temp/reports/en_fup_0000015380_20140610_17541...).

In May 2017, the OIE updated its case definition for the reporting of MERS-CoV, as follows:

"1. Introduction
Dromedary camels have been confirmed by several studies to be the reservoir of the MERS-CoV infection in humans. Zoonotic transmissions of MERS-CoV from dromedary camels to humans were reported in multiple occasions. MERS-CoV has never been reported as a disease in camels though in experimental infections MERS-CoV has been associated with mild upper respiratory signs. Positive PCR results for MERS-CoV or isolation of the virus from camels is notifiable to the OIE because MERS is an emerging disease with a significant public health impact.

2. Confirmed case:
A dromedary camel with laboratory confirmation (*note 1) of MERS-CoV infection, with or without clinical signs.

3. Suspected case:
a) Observed clinical signs of mild respiratory infection (rhinitis in young dromedaries); and
b) Direct epidemiologic link (*note 2) with a confirmed human or camel MERS-CoV case; and
c) Testing for MERS-CoV is unavailable, negative or inconclusive (*note 4) on a single inadequate specimen (*note 3).

Notes
1 A case may be laboratory confirmed by virus isolation or detection of viral nucleic acid. The presence of viral nucleic acid can be confirmed by 1) a positive RT-PCR result on at least 2 specific genomic targets,
2) a single positive target with sequencing of a 2nd target or
3) a single positive target with positive result in a rapid MERS-CoV Ag Test. Serological investigations are of little value as high percentage of tested dromedaries possess antibodies to MERS-CoV.

2. A direct epidemiological link with a confirmed MERS-CoV dromedary camel may include living or traveling together in close proximity or sharing the same environment with individual dromedaries infected with MERS-CoV.

3. An inadequate specimen would include a specimen that has had improper handling, is judged to be of poor quality by the testing laboratory, or was taken too late in the course of illness.

4. Inconclusive tests may include a positive screening test on a single rRT-PCR target without further confirmation. Animals with an inconclusive initial test should undergo additional sampling and testing to determine if the animal can be classified as a confirmed MERS-CoV case. At herd level, having positive single target PCRs in more than one animal could constitute confirmation. Preference should be a repeat nasopharyngeal specimen. Other types of clinical specimens could also be considered for molecular testing if necessary, including blood/serum, and stool/rectal swab. These generally have lower titers of virus than respiratory tract specimens but have been used to confirm cases when other specimens were inadequate or unobtainable".

As commented by Mod.MPP (see 20170524.5059234), according to a review of cases reported by Saudi Arabia and classified as "primary" cases (N=560), 27.3 percent had a history of camel exposure, and 72.7 percent were reported as still under investigation for high risk exposures at the time of initial confirmation report. The 85th General Session of the World Assembly of OIE Delegates has been held in Paris during this week (21 to 26 May 2017). According to WHO updated information, MERS-CoV has caused, since its initial detection in Sep 2012, at least 1952 human cases, of which at least 693 deaths in 27 countries. It will be interesting to note if the reporting of this disease, according to the OIE criteria, and its possible control in the animal reservoir have been discussed during the General Session.

Subscribers are referred to a recent review paper (Ref 1), and in particular to figure 3 "Hypothesis of MERS-CoV transmission to humans".

A One Health approach to the MERS-CoV issue, its epidemiology and control, will require the active involvement of the 3 relevant international authorities, namely the FAO, OIE and WHO.

References
M. G. Hemida, A. Elmoslemany, F. Al-Hizab, A. Alnaeem, F. Almathen, B. Faye, D. K. W. Chu, R. A. P. M. Perera & M. Peiris. Dromedary Camels and the Transmission of Middle East. Transboundary & Emerging Diseases 64 (2017) 344-353.
http://agritrop.cirad.fr/580073/7/Hemida_et_al-2017-Transboundary_and_Em.... - Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/130.]

See Also

MERS-CoV (28): Qatar, Saudi Arabia (HA) 20170524.5059234
MERS-CoV (23): Saudi Arabia (AS) animal reservoir, human contact, OIE, RFI 20170421.4986081
MERS-CoV (21): Egypt, animal reservoir, camel, ex Sudan, control, RFI 20170405.4948727
MERS-CoV (18): Africa, animal reservoir, camels, 2015, research 20170331.4939980
2016
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MERS-CoV (87): Jordan, animal reservoir, camelids, OIE 20160802.4385317
MERS-CoV (66): Saudi Arabia, animal reservoir, camelids, OIE, RFI 20160618.4294807
MERS-CoV (59): animal reservoir, review 20160610.4275921
MERS-CoV (40): Egypt, animal reservoir, camel, ex Sudan, susp. 20160316.4097730
MERS CoV (21): Saudi Arabia, animal reservoir, camel, comment 20160216.4023772
MERS CoV (19): Saudi Arabia, animal reservoir, camel, prevention, RFI 20160204.3995194
MERS-CoV (18): Saudi Arabia, animal reservoir, camel, vaccination, comment 20160203.3990284
MERS-CoV (16): Saudi Arabia (MK) animal reservoir, OIE, RFI 20160201.3985175
MERS-CoV (11): Saudi Arabia, animal reservoir, camel, vaccination, comment 20160126.3966528
MERS-CoV (09): Saudi Arabia, animal reservoir, camel, vaccination considered 20160125.3963370
2015
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MERS-CoV (163): Saudi Arabia, animal reservoir, camel, research, vaccine 20151219.3873486
MERS-CoV (155): animal reservoir, camel, research, RFI 20151110.3781744
MERS-CoV (154): Saudi Arabia, animal reservoir, camel, case control 20151105.3768115
MERS-CoV (143): Kenya, animal reservoir, camel, serosurveillance 20151017.3722887
MERS-CoV (141): Saudi Arabia, animal reservoir, camel debated, RFI 20151016.3720479
MERS-CoV (131): Saudi Arabia, animal reservoir, camels, Hajj, RFI 20150914.3643612
MERS-CoV (130): Saudi Arabia, animal reservoir, camels, Hajj 20150912.3641457
MERS-CoV (114): Saudi Arabia, animal reservoir, camels, Hajj 20150823.3597358
MERS-CoV (104): Saudi Arabia, animal reservoir, camel debate 20150810.3569207
MERS-CoV (63): animal reservoir, bat 20150612.3432410
MERS-CoV (48): UAE (Dubai) animal reservoir, camel 20150527.3386738
MERS-CoV (29): UAE (Dubai) animal reservoir, camel 20150303.3204214
MERS-CoV (27): Saudi Arabia, animal reservoir, camel 20150302.3200502
MERS-CoV (12): animal reservoir, camels debated, case-control study, RFI 20150122.3109335
MERS-CoV (09): Saudi Arabia, animal reservoir, camels debated 20150117.3098294
2014
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MERS-CoV (67): Iran (SB) animal reservoir, camel, ex Pakistan, RFI 20141219.3039497
MERS-CoV (49): Iran (SB), animal reservoir, camel conf, OIE 20141029.2912385
MERS-CoV (46): animal reservoir, camel, S.Arabia, vaccination, Iran susp, RFI 20141027.2904032
MERS-CoV (40): animal reservoir, camel, milk susp, RFI 20141022.2889778
MERS-CoV (24): animal reservoir, camel, experimental infection 20140929.2813981
MERS-CoV (09): animal reservoir, update, OIE, WHO 20140818.2700879
MERS-CoV (07): animal reservoir, camel, bat 20140720.2623848
MERS-CoV - Eastern Mediterranean (79): Qatar (OIE) Kuwait (susp) animal res, RFI 20140611.2533756
MERS-CoV - Eastern Mediterranean (77): S Arabia, Qatar, animal res, control, RFI 20140607.2525113
MERS-CoV - Eastern Mediterranean (75): Animal res, camel, zoonotic aspects 20140604.2518134
MERS-CoV - Eastern Mediterranean (66): Oman (SH), camel conf, OIE 20140523.2493556
MERS-CoV - Eastern Mediterranean (62): Saudi Arabia, Africa, animal res., camel 20140517.2478989
MERS-CoV - Eastern Mediterranean (46): Saudi Arabia, animal reservoir, camel 20140430.2440228
MERS-CoV - Eastern Mediterranean (41): Oman, animal reservoir, camel 20140426.2432011
MERS-CoV - Eastern Mediterranean (39): Qatar (RY) animal res., camel, OIE 20140424.2426491
MERS-CoV - Eastern Mediterranean (34): animal reservoir, camel, Saudi Arabia, RFI 20140419.2414479
MERS-CoV - Eastern Mediterranean (19): Saudi Arabia, UAE, WHO 20140325.2356854
MERS-CoV - Eastern Mediterranean (10): camel, Sudan, Ethiopia 20140228.2307254
MERS-CoV - Eastern Mediterranean (09): animal reservoir, camel, Saudi Arabia 20140227.2303420
MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807
2013
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MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat 20131217.2120936
MERS-CoV - Eastern Mediterranean (98): animal reserv/camel, Jordan, Saudi Arabia 20131213.2114362
MERS-CoV - Eastern Mediterranean (95): animal reservoir, camel, Qatar 20131129.2082942
MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar 20131129.2082330
MERS-CoV - Eastern Mediterranean (93): animal res., camel conf, Qatar (RY) OIE 20131129.2082115
MERS-CoV - Eastern Mediterranean (87): animal res. camel susp. precautions 20131113.2053932
MERS-CoV - Eastern Mediterranean (85): animal reservoir, camel, susp, official 20131112.2051424
MERS-CoV - Eastern Mediterranean (83): animal reservoir, camel, susp, RFI 20131112.2050868
MERS-CoV - Eastern Mediterranean (75): role of bats in emergence, Saudi Arabia new cases 20131011.1996687
MERS-CoV - Eastern Mediterranean (68): animal reservoir, camel, research 20130907.1929762
MERS-CoV - Eastern Mediterranean (66): animal reservoir, discussion 20130904.1922998
MERS-CoV - Eastern Mediterranean (61): animal reservoir, bat, comment 20130828.1907567
MERS-CoV - Eastern Mediterranean (57): animal reservoir, bats 20130822.1895035
MERS-CoV - Eastern Mediterranean (53): animal reservoir, serology, FAO 20130811.1875301
MERS-CoV - Eastern Mediterranean (52): animal reservoir, research, serology 20130809.1872008
MERS-CoV - Eastern Mediterranean (50): animal reservoir, OIE 20130727.1849047
MERS-CoV - Eastern Mediterranean (48): animal reservoir, bat susp 20130725.1844412
MERS-CoV - Eastern Mediterranean (39): animal reservoir, research 20130706.1810714
MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, genome 20130612.1768944
MERS-CoV - Eastern Mediterranean (10): animal reservoir, research 20130524.1735984
MERS-CoV - Eastern Mediterranean (03): animal reservoir, RFI 20130519.1723544
MERS-CoV - Eastern Mediterranean (02): WHO summary, ECDC risk assessments 20130518.1721873
Novel coronavirus - Eastern Mediterranean (15): camel exposure 20130405.1623188
Novel coronavirus - Eastern Mediterranean: bat reservoir 20130122.1508656
2012
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Novel coronavirus - Eastern Mediterranean (06): comments 20121225.1468821
Novel coronavirus - Eastern Mediterranean (05): WHO, transmission route 20121223.1465597
Novel coronavirus - Eastern Mediterranean (04): receptor charact. 20121211.1446670
Novel coronavirus - Eastern Mediterranean (03): research, ISARIC (UK) 20121208.1443486
Novel coronavirus - Eastern Mediterranean (02): diagnostics 20121207.1442473
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (19): Singapore: NOT 20121129.1430397
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia (10): WHO, revised case def. 20120930.1315960
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733
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