MERS-COV (44): LEBANON ex SAUDI ARABIA, SAUDI ARABIA, EXPERIMENTAL ANTIVIRAL, REQUEST FOR INFORMATION

Posted on 06TH JUL 2017
tagged MERS-CoV, Lebanon; Saudi Arabia

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Lebanon ex Saudi Arabia - ECDC CDTR, RFI
[2] Lebanon ex Saudi Arabia - Lebanon MOH 19 Jun 2017 [accessed 1 Jul 2017] [In Arabic, mach.trans, edited], RFI
[3] Saudi Arabia 1 new case - Saudi MOH 29 Jun - 1 Jul 2017
[4] New antiviral agent

******
[1] Lebanon ex Saudi Arabia - ECDC CDTR, RFI
Date: Sat 1 Jul 2017
Source: ECDC Communicable Disease Threats Report 1 Jul 2017 [edited]
https://ecdc.europa.eu/sites/portal/files/documents/Communicable-disease...

Middle East respiratory syndrome coronavirus (MERS-CoV) - Multistate
Opening date: [24 Sep 2012] Latest update: [30 Jun 2017]

Epidemiological summary
Since the last update of MERS-CoV on [9 Jun 2017], 41 additional cases of MERS-CoV have been reported, 40 from Saudi Arabia and one reported by Lebanon in a Lebanese citizen returning from Saudi Arabia.

Saudi Arabia: among the 40 recently reported cases on [19 Jun 2017], 13 are associated to 2 previously identify clusters.

The 1st cluster is related to nosocomial transmission in a hospital of Riyadh where 32 cases have been laboratory confirmed. All the cases were asymptomatic.

The 2nd cluster is also related to nosocomial transmission in another hospital in Riyadh where one suspect case and 8 laboratory confirmed cases have been identified.

A 3rd cluster was reported in a 3rd hospital in Riyadh on [13 June 2017]. This cluster includes 6 cases, including one asymptomatic case who visited the emergency room of the hospital of the 1st cluster. The other 5 cases are secondary household and health care worker contacts.

Lebanon: on [28 June 2017], Lebanon reported one imported case from Saudi Arabia. The case developed symptoms before traveling back from Saudi Arabia to Lebanon. The patient is isolated at home and authorities started contact tracing.

One case of MERS has previously been reported in Lebanon on 9 May 2014.

According to WHO, since April 2012 and as of [30 June 2017], 2030 cases of MERS, including 704 deaths, have been reported by health authorities worldwide.

ECDC assessment
The extent to which healthcare facilities in Riyadh are affected is unknown, as is the number of asymptomatic individuals who may be infected with MERS-CoV. The role of hospitals as amplifiers of MERS-CoV infection is now well known, making the strict and timely application of infection prevention and control measures imperative. Sporadic, imported cases can be expected in EU/EEA Member States, and are associated with a risk of nosocomial spread. This highlights the need for awareness among healthcare workers, early detection through functioning testing algorithms, preparedness planning and application of strict infection prevention and control measures.

The risk of sustained human-to-human transmission in Europe remains very low. ECDC's conclusion continues to be that the MERS-CoV outbreak poses a low risk to the EU, as stated in a rapid risk assessment published on 21 October 2015, which provides details on the last case reported in Europe.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The HealthMap/ProMED map of Lebanon can be found at: http://healthmap.org/promed/p/85. - Mod.MPP]

******
[2] Lebanon ex Saudi Arabia - Lebanon MOH 16 Jun 2017 [accessed 1 Jul 2017] [In Arabic, mach.trans, edited] RFI
Date: Mon 19 Jun 2017
Source: Lebanon MOH 19 Jun 2017 [accessed 1 Jul 2017] [in Arabic, mach.trans, edited]
http://www.moph.gov.lb/en/Media/view/12880/1/press-release-on-19-06-2017...

Press Release on [19 Jun 2017] Concerning the diagnosis of a MERS-Coronavirus infection

The Ministry of Public Health report on the diagnosis of a human infection with the MERS-CoV on 16 Jun 2017

The patient returned to Lebanon from Saudi Arabia complaining of several days of high fever, without acute respiratory symptoms. He received the necessary treatment and is currently in good health at his home where he is subjected to domestic isolation and control by the Ministry of Public Health. The Ministry is also monitoring all identified contacts of the patient and those who were near him during his travel to and residence in Lebanon.

Note that this is the 2nd case of MERS-CoV infection diagnosed in Lebanon, the 1st case having been recorded in 2014. That case was also treated with preventive measures and did not result in transmission of the virus to other individuals in Lebanon.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[As mentioned above, this is the 2nd laboratory confirmed case of MERS-CoV infection reported by Lebanon. Interestingly, the 1st reported case (9 Jun 2014) was an individual who had returned to Lebanon after traveling in the Gulf region, including to Saudi Arabia. (see MERS-CoV - Eastern Mediterranean (54): Saudi Arabia, Lebanon 20140509.2461876 and MERS-CoV - Eastern Mediterranean (53): Saudi Arabia, Lebanon, RFI 20140509.2459095).

Neither one of the above reports on this case provide demographic nor epidemiologic information other than the case occurred in a Lebanese citizen who traveled to Saudi Arabia. More information detailing the age, gender, location of travel in Saudi Arabia, possible high risk exposures while there (contact with camels, camel products, contact with the health facilities, contact with any known MERS-CoV infected individual) and purpose of trip to Saudi Arabia (was the individual participating in Umrah, attending business meetings, a tourist). ProMED-mail would greatly appreciate receiving more information from knowledgeable sources. - Mod.MPP]

******
[3] Saudi Arabia 1 new case - Saudi MOH 29 Jun - 1 Jul 2017
Date: Sat 1 Jul 2017
Source: Saudi MOH 29 Jun - 1 Jul 2017 [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of today [Sat 1 Jul 2017], there have been a total of:
1672 laboratory-confirmed cases of MERS-CoV infection, including
678 deaths [reported case fatality rate 40.6 percent],
974 recoveries, and
20 currently active cases/infections.

[As previously mentioned, the numbers of deaths, recoveries and currently active cases come from my spreadsheet tallies differ from those listed on the Saudi MOH website; my spreadsheet counts asymptomatic infections.]

Since the last ProMED-mail update [28 Jun 2017], there have been a total of:
1 newly confirmed case/infection
1 newly reported fatality, and
4 newly reported recoveries.

Information on newly confirmed case/infection with MERS-CoV
Date: Sat 1 Jul 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-07-01-0...

- A 70-year-old Saudi male, non-healthcare worker, from Al Baha [Al Bāhah Region] currently in stable condition. Classification still under review.

Information on newly reported fatality:
Date: Fri 30 Jun 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-06-30-0...

- A 70-year-old Saudi male, non-healthcare worker from Riyadh [Riyadh region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 23 Jun 2017 at which time he was noted to be in critical condition. At the time of initial confirmation report, classification was still pending.

Information on newly reported recoveries (4 recoveries)
- All 4 were from Riyadh

Date: Fri 30 Jun 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-06-30-0...

1 - A 47-year-old Saudi male, non-healthcare worker, with a history of pre-existing co-morbidities, [Most likely the same individual reported by the MOH as a 40-year-old on 14 Jun 2017, at which time he was noted to be in stable condition. Classified as a primary case with high risk exposure history still under investigation. - Mod.MPP]

2 - A 57-year-old expat male, healthcare worker, with history of pre-existing co-morbidities. [reported as a newly confirmed case on 11 Jun 2017 at which time he was noted to be in stable condition. Classified as a secondary healthcare acquired case in a healthcare worker. - Mod.MPP]

Date: Thu 29 Jun 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-06-29-0...

3 - A 46-year-old expat male, non-healthcare worker, with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 4 Jun 2017 at which time he was noted to be in stable condition, having been identified as an asymptomatic contact of a previously confirmed MERS-CoV infected individual. Classified as a secondary healthcare acquired case in a patient. - Mod.MPP]

4- A 30-year-old expat female, healthcare worker, with no history of co-morbidities. [reported as a newly confirmed case either on 2 or 8 Jun 2017 at which time she was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed MERS-CoV infected individual. Classified as a secondary healthcare acquired case in a healthcare worker. - Mod.MPP]

--
Communicated by:
ProMED-mail

[In the past few days since the last update [28 Jun 2017] there has only been one newly confirmed case of MERS-CoV infection reported by Saudi Arabia. The case was reported from Baha, where there had been a previously reported case on 23 Jun 2017 who died on 30 Jun 2017 (see details above on fatal case reported during this period). Of note is that today marks 14 days since the most recent reported nosocomial transmitted case in Riyadh, and hopefully signals that the nosocomial transmission has been interrupted.

Maps showing the locations of the reported case, fatality and recoveries can be found at the source URLs.

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

******
[4] New antiviral agent
Date: Thu 29 Jun 2017
Source: Science Daily [edited]
https://www.sciencedaily.com/releases/2017/06/170629123855.htm

New antiviral drug inhibits epidemic SARS, MERS and animal coronaviruses
Source: Vanderbilt University Medical Center

Summary:
A new antiviral drug candidate inhibits a broad range of coronaviruses, including the SARS and MERS coronaviruses, a multi-institutional team of investigators reports. The findings support further development of the drug candidate for treating and preventing current coronavirus infections and potential future epidemic outbreaks.

A new antiviral drug candidate inhibits a broad range of coronaviruses, including the SARS and MERS coronaviruses, a multi-institutional team of investigators reports this week [week of 25 Jun-1 Jul 2017] in Science Translational Medicine. The findings support further development of the drug candidate for treating and preventing current coronavirus infections and potential future epidemic outbreaks.

Coronaviruses are a genetically diverse family of viruses that infect birds and mammals, with most coronavirus strains limited to infecting only certain hosts. Human coronaviruses, for example, cause up to 30 percent of common colds.

In the last 15 years, however, coronaviruses have demonstrated their ability to jump into new species. Zoonotic (animal) coronaviruses have infected humans, causing severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), severe diseases with high mortality rates ranging from 10 percent for SARS to 40 percent for MERS. The MERS-coronavirus continues to cause new infections in the Middle East.

"There's a real concern that the MERS coronavirus could escape broadly when millions of people visit Saudi Arabia for the Hajj," said Mark Denison, M.D., Craig-Weaver Professor of Pediatrics and professor of Pathology, Microbiology and Immunology at Vanderbilt University School of Medicine.

But to date, there has been no effective antiviral drug for any known coronavirus, Denison noted.

Denison and his team at Vanderbilt have studied the basic biology of coronaviruses for more than 20 years. In an effort to find chemical tools that would allow them to probe viral replication, graduate student Brett Case screened a series of compounds selected and provided by Gilead Sciences.

Case demonstrated that one of the compounds was highly active against coronaviruses in cultured cells. The finding was a surprise, Denison said, because compounds in the same class (nucleoside analogs) have normally failed to inhibit coronavirus replication.

The compound, called GS-5734, is currently in clinical development for treatment of Ebola virus disease.

Denison's longtime collaborator Ralph Baric, Ph.D., at the University of North Carolina and his team demonstrated that GS-5734 inhibits SARS-coronavirus and MERS-coronavirus replication in multiple in vitro systems, including cultures of primary human airway epithelial cells, which are the cells infected by respiratory coronaviruses.

The researchers also showed that GS-5734 was effective against a circulating human coronavirus, bat coronaviruses, and bat coronaviruses that are considered "prepandemic" because they can infect cultured human cells.

Using a mouse model of SARS, the investigators demonstrated that both prophylactic (before infection) and early therapeutic (soon after infection) administration of GS-5734 reduced viral load in the lungs and improved respiratory functions.

"This compound shows broad activity against a variety of human and animal coronaviruses and represents an exciting potential therapeutic for a family of viruses prone to emergence from animal reservoirs," Denison said.

Denison and his team at Vanderbilt will continue to use the compound "as a probe to try to understand the biology of the virus, how and why this drug works, and to identify new targets for inhibiting coronaviruses," he said.

"This is an exciting example of how pursuing fundamental research to understand the mechanisms of virus replication and pathogenesis can lead to an important compound with therapeutic potential."

Journal Reference:
Timothy P. Sheahan et al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Science Translational Medicine, June 2017 DOI: 10.1126/scitranslmed.aal3653 [full article available at: http://stm.sciencemag.org/content/9/396/eaal3653.full]

--
Communicated by:
ProMED-mail

[We usually shy away from posting early studies on possible new biologics or antimicrobial agents as many new promising agents look very promising in in vitro studies and in laboratory animal models but when transferred to humans either fail in terms of safety or in terms of efficacy. That being said, for those interested in the field, I strongly recommend reading this article. In the past 15 years, we've dealt with 2 coronaviruses that have done species jump from bats through intermediary hosts into humans with significant mortality. In 2002-2003 there was the SARS-CoV and since 2012 the MERS-CoV. In both cases, no existing antiviral agents have been effective therapeutically, with the MERS-CoV having a reported case fatality rate of approximately 40 percent (reported by Saudi Arabia, and somewhat less on the global level). - Mod.MPP]

See Also

MERS-CoV (43): Saudi Arabia, WHO 20170628.5137634
MERS-CoV (42): Saudi Arabia (RI, SH, MD), WHO 20170628.5136101
MERS-CoV (41): Saudi Arabia (RI, SH) 20170620.5117143
MERS-CoV (40): animal reservoir, camels, review, FAO 20170619.5115999
MERS-CoV (39): Saudi Arabia (RI), nosocomial transmission 20170615.5108781
MERS-CoV (38): Saudi Arabia (RI), nosocomial transmission, WHO 20170613.5102806
MERS-CoV (37): Saudi Arabia (RI), nosocomial transmission, fatal 20170611.5098598
MERS-CoV (36): Saudi Arabia (RI), nosocomial transmission
MERS-CoV (35): Saudi Arabia (RI), nosocomial and household transmission 20170608.5093008
MERS-CoV (34): Saudi Arabia, UAE, Qatar, WHO 20170606.5087888
MERS-CoV (33): Saudi Arabia (RI), nosocomial transmission 20170605.5085681
MERS-CoV (32): Saudi Arabia (RI,MD) 20170604.5083353
MERS-CoV (31): Saudi Arabia (MK,RI) nosocomial transmission 20170604.5082194
MERS-CoV (30): Saudi Arabia (RI,MD,MK) 20170602.5077920
MERS-CoV (27): Saudi Arabia (RI,AS,QS) nosocomial transmission 20170519.5049088
MERS-CoV (20): Qatar, Saudi Arabia, WHO 20170404.4947466
MERS-CoV (10): Saudi Arabia (SH, MK) 20170202.4811346
MERS-CoV (04): Saudi Arabia (MK, QS), nosocomial outbreak, RFI 20170110.4754928
MERS-CoV (02): Saudi Arabia (QS) nosocomial transmission 20170107.4748974
MERS-CoV (01): Saudi Arabia (QS,RI,MD), RFI 20170105.4744802
2016
----
MERS-CoV (123): Saudi Arabia (MK, AS) new cases 20161231.4734758
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188
2015
----
MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383
2014
----
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 (54): Saudi Arabia, Lebanon 20140509.2461876
MERS-CoV - Eastern Mediterranean (53): Saudi Arabia, Lebanon, RFI 20140509.2459095
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
2013
----
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
2012
----
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
.................................................sb/mpp/ec/ml