Middle East respiratory syndrome coronavirus (MERS-CoV): threats, gaps and containment strategies

Abstract

Presenter: Hamid Hussain, Consultant, Family and Community Medicine, Faculty of Medicine, University of Baghdad; Dubai Health Authority, Dubai, United Arab Emirates Background: Middle East respiratory syndrome coronavirus (MERS-CoV) causing acute severe respiratory diseases was first reported in 2012 in Saudi Arabia. The causative agent was identified as a coronavirus which was named MERS-CoV. Purpose: This study reviewed the published literature to investigate the incidence and mortality rate of MERS-CoV to identify the main threats and gaps and frame containment strategies. Methodology: MEDLINE and CINAHL electronic databases were searched using a pre-defined search strategy. Additional references from the bibliographies of retrieved articles were also reviewed and experts (respiratory disease consultants) involved in case management in the United Arab Emirates were contacted. Selection criteria were: original research articles on MERS-CoV incidence. The initial literature search identified 47 papers. Of these, 16 original articles met the selection criteria. All were type II evidence— population-based clinical MERS-CoV studies. Findings: Since 2012 cases have been reported in 14 countries, with most of the reporting from the Arabian Peninsula region. A total of 212 cases have been reported in Saudi Arabia up to April 2014, of which 88 died. The countries most affected by the disease are Saudi Arabia with 183 cases, of which 74 (40 %) died and the United Arab Emirates with 19 cases, of which 7 (37 %) died. So far, all the cases have been linked to six countries in or near the Arabian Peninsula. No cases have been identified in the United States of America. The virus has spread from sick people to others through close contact. Conclusions: The disease is following a propagated epidemic curve and trending to more spreading and adding more and more cases. In time, increasing numbers of index cases will lead to a change in the epidemiological curve pattern to an explosive epidemic curve, which is considered threatening for coronavirus as the case fatality rate is extremely high and mortality rate can reach up to 50 %. Gap analysis studies are needed to determine why the virus is still circulating and propagating in spite of the advanced preventive and control measures applied so far. The main question that needs to be addressed is how to reach the sources of infection and to break the transmission chain. Keywords MERS-CoV; Incidence