Posted on 13TH OCT 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] Saudi Arabia: Ministry of Health reports
[2] Pakistan serosurvey

[1] Saudi Arabia: Ministry of Health reports
Date: Thu 11 Oct 2018
Source: Saudi Ministry of Health 4-11 Oct 2018 [edited]

Newly confirmed cases (2):
Date of report: 11 Oct 2018
Case no. 18-1758
MERS in Almoai city: 41-year-old female in Almoai city, Taif region
Contact with camels: Yes
Case classification: Primary, community acquired
Current status: Hospitalized

Date of report: 4 Oct 2018
Case no. 18-1757
MERS in Najran city: 49-year-old male in Najran city, Najran region
Contact with camels: Yes
Case classification: Primary, community acquired
Current status: Hospitalized

Outcome reports during this period:

Case no. 18-1756
1st confirmation report: 3 Oct 2018
Date of outcome report: 10 Oct 2018
Outcome: Recovery
Location: Afeef, Riyadh region
22-year-old male
Non-healthcare worker
Treatment location: Home isolation
History of camel contact

Case no. 18-1755
1st confirmation report: 29 Sep 2018
Date of outcome report: 8 Oct 2018
Outcome: Recovery
Location: Buraidah, Al Qasim region
65-year-old Saudi male
Non-healthcare worker
Treatment location: Hospitalized
No history of camel contact

Communicated by:

[Since the beginning of October 2018, there have been 3 cases of MERS-CoV infection reported by the Saudi Ministry of Health (MoH). Of the 3 cases, 2 were hospitalized and one was managed on home isolation. One case was a secondary household contact of a previously confirmed case, whereas the other 2 cases had a history of contact with camels. The cases came from 3 different regions: Riyadh, Najran, and Makkah (referred to as Taif region in the MoH report). It is hoped that October [2018] will continue to be a "quiet" month for MERS-CoV transmission. - Mod.MPP

HealthMap/ProMED-mail maps:
Saudi Arabia:
Najran Province, Saudi Arabia:
Makkah Province, Saudi Arabia:]

[2] Pakistan serosurvey
Date: Thu 11 Oct 2018
Source: Springer Virologica Sinica [edited]

Zohaib A, Saqib M, Athar MA, et al. Countrywide survey for MERS-coronavirus antibodies in dromedaries and humans in Pakistan. Virol Sin 2018. doi: 1st online 11 Oct 2018.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic pathogen capable of causing severe respiratory disease in humans. Although dromedary camels are considered a major reservoir host, the MERS-CoV infection dynamics in camels are not fully understood. Through surveillance in Pakistan, nasal (n  =  776) and serum (n  =  1050) samples were collected from camels between November 2015 and February 2018. Samples were collected from animal markets, free-roaming herds, and abattoirs. An in-house ELISA was developed to detect IgG against MERS-CoV. A total of 794 camels were found seropositive for MERS-CoV. Prevalence increased with age, and the highest seroprevalence was recorded in camels older than  10 years (81.37%) followed by those aged 3.1 to 10 years (78.65%) and  3 years or younger (58.19%). Higher prevalence was observed in females (78.13%) compared with males (70.70%). Of the camel nasal swabs, 22 were found to be positive by RT-qPCR, although with high Ct values. Moreover, 2409 human serum samples were also collected from 4 provinces of Pakistan during 2016 to 2017. Among the sampled population, 840 humans were camel herders. Although we found a high rate of MERS-CoV antibody-positive dromedaries (75.62%) in Pakistan, no neutralizing antibodies were detected in humans with and without contact to camels.

Communicated by:

[Another foray into trying to unravel the mystery of "why the Middle East," when there are dromedary camels in North Africa and Pakistan. Studies have identified seropositivity in dromedaries in Nigeria, Kenya, and now Pakistan with minimal to no evidence of seropositivity in humans who had frequent contact with these camels. The mystery remains.... - Mod.MPP

Pakistan is one of 8 countries globally, and the only country outside Africa, that has a dromedary population exceeding one million animals. In a previous study, by the same study group, that was limited to Pakistan's Punjab region, up to 39.5% of 565 dromedary sera collected between 2012 and 2015 had neutralizing antibodies against MERS-CoV (Saqib et al. [4]). Seropositivity increased with age: More than half of animals older than 5 years were seropositive compared with less than one-third of animals under the age of 2 years. Because Punjab shares a border with the state of Rajasthan in India, where India's largest dromedary population is maintained, the authors suggested that a similar risk for human exposure is likely for this part of India. They concluded that the data obtained exclude the scenario of a widely susceptible animal reservoir population in which de novo introduction of MERS-CoV could start an epizootic that could lead to spillover epidemics among humans. The current (2018) paper, covering the entire country, underlines the said conclusion. However, in the current study, a high seroprevalence of MERS-CoV was found among young camels (58.19%), indicative of recent active circulation of MERS-CoV in the dromedary population of Pakistan. The active circulation of the virus is further confirmed by the detection of MERS-CoV in 22 nasal swab samples. Although the continuous circulation of MERS-CoV in the camel population of Pakistan is expected to pose a possible risk of transmission to camel herders and other people who have frequent contact with camels or their products, the revealed absence of such human cases is seen by the authors as posing "a germane question regarding the viral epidemiology in different geographic and ecological zones." Subscribers are referred to an early report on suspected MERS-CoV activity in Pakistani dromedaries, when Iran reported to the OIE in December 2014 about the detection of positive serology in camels illegally imported into Iran from Pakistan's Baluchistan (see 20141219.3039497). - Mod.AS

1. So RTY, Perera RAPM, Oladipo JO, et al. Lack of serological evidence of Middle East respiratory syndrome coronavirus infection in virus-exposed camel abattoir workers in Nigeria, 2016. Euro Surveill 2018;23(32):pii=1800175. doi:
2. Munyua P, Corman VM, Bitek A, et al. No serologic evidence of Middle East respiratory syndrome coronavirus infection among camel farmers exposed to highly seropositive camel herds: a household linked study, Kenya, 2013. Am J Trop Med Hyg 2017;96(6):1318-1324. doi:
3. Liljander AM, Meyer B, Jores J, et al. MERS-CoV antibodies in humans, Africa, 2013-2014. Emerg Infect Dis 2016;22(6):1086-1089. doi:
4. Saqib M, Sieberg A, Hussain MH, et al. Serologic evidence for MERS-CoV infection in dromedary camels, Punjab, Pakistan, 2012-2015. Emerg Infect Dis 2017;23:550-551. doi:

HealthMap/ProMED-mail map:

See Also
MERS-CoV (40): Saudi Arabia (RI) WHO 20181003.6069065
MERS-CoV (39): Saudi Arabia (QS, RI) South Korea 20180929.6060992
MERS-CoV (38): Saudi Arabia (RI, QS) South Korea 20180916.6033021
MERS-CoV (37): Saudi Arabia (SH), South Korea ex Kuwait, WHO 20180912.6025675
MERS-CoV (36): Saudi Arabia, South Korea, contact tracing, WHO 20180911.6023092
MERS-CoV (35): South Korea ex Kuwait 20180908.6016517
MERS-CoV (34): Saudi Arabia (QS) clarification 20180906.6012360
MERS-CoV (33): Saudi Arabia: (QS) RFI 20180904.6006491
MERS-CoV (32): Saudi Arabia (QS) 20180903.6004712
MERS-CoV (31): Saudi Arabia (RI, QS), UK (England) ex Saudi Arabia, WHO 20180901.6002235
MERS-CoV (30): Saudi Arabia (RI) new case 20180830.5998414
MERS-CoV (20): Saudi Arabia (NJ) susp. family cluster 20180602.5835120
MERS-CoV (10): Oman, Saudi Arabia, WHO 20180315.5690014
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 (67): Iran (SB) animal reservoir, camel, ex Pakistan, RFI 20141219.3039497
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