Detection of MERS Circulation in Kuwait

Abstract

In June 2012, a previously unknown human coronavirus was isolated from a 60 year-old Saudi-Arabian patient who died from acute respiratory distress syndrome and multiple organ failure [1]. Subsequently, the novel virus was detected from several additional residents and visitors of the Arabian Peninsula countries including Saudi Arabia, Jordan, Qatar, and the United Arab Emirates (UAE). This virus is currently called Middle East Respiratory Syndrome virus (MERS-CoV). It is the first virus belonging to betacoronavirus lineage C that has been associated with human disease. Globally, from September 2012 to date, WHO has been informed of a total of 157 laboratoryconfirmed cases of infection with MERS-CoV, including 66 deaths [2]. It is recommended for physicians to be vigilant toward testing for MERS-CoV. Other potential causes of respiratory infections should be ruled out using routinely available laboratory tests. Lower respiratory tract samples such as bronchoalveolar lavage are recommended better than upper respiratory tract samples to test for MERS-CoV. A number of RT-PCR assays that are specific for the novel coronavirus have been developed. These include an assay targeting upstream the E protein gene (upE), an assay targeting the open reading frame 1b (ORF 1b) gene and an assay targeting the open reading frame 1a (ORF 1a) gene [3]. The assay for the upE target is considered highly sensitive, with the ORF 1a assay believed to be of equal sensitivity. The ORF 1b assay is considered less sensitive than the ORF 1a assay but may be more specific [3]. By November of 2012, the virus had already been discovered in multiple countries in the Arabian peninsula including Qatar, Jordan and Saudia Arabia .In that time it was also feared that the virus also circulated in Kuwait. The situation was made worse by the arrival of the Hajj season when several thousands of KUWAITI people traveled to Saudi Arabia in the presence of the virus which behavior was unknown. Therefore, MERS-CoV PCR was established targeting ORF-1b in the virology unit in Mubarak Alkabeer Hospital Faculty of Medicine, Kuwait in December of 2012 to screen for the presence of the virus in the country as a cause of severe respiratory tract infection and to detect any imported cases. On November, 2013 another method was replaced to test for MERS-CoV after screening with upE is ModularDx Kit corona Orf1a by TIB and the previous method is now used as secondary test. Almost one year after the identification of the new virus we would like to report our experience.