TIME Infectious Disease

It Looks Like Camels Actually Can Transmit MERS to Humans

Camel MERS
An Indian worker wears a mouth and nose mask as he touches a camel at his Saudi employer's farm outside Riyadh on May 12, 2014. Fayez Nureldine—AFP/Getty Images

Scientists confirm a man who died of MERS had same virus as one of his camels

Genetic sequencing has confirmed that a man who died of MERS in November likely got the disease from one of the camels in his herd.

In Nov, 2013, a 44-year-old previously healthy Saudi Arabian man came down with MERS and eventually died. A new study published in The New England Journal of Medicine reports that scientists from King Abdulaziz University in Jeddah have shown that his virus was virtually identical to the virus found in one of his camels.

The scientists report that three of the man’s friends accompanied him when he visited his camels and witnessed him put medicine in the nose of calf. Later on, it was shown that the calf had the same virus as the man, suggesting he got MERS from his camel.

The man’s friends and daughter, who also had cold symptoms recovered, as did the camel.

TIME Infectious Disease

Saudi Arabia Revises MERS Death Toll Up 48%

SAUDI-HEALTH-MERS-VIRUS
A Saudi man walks towards the King Fahad hospital in the city of Hofuf, 370 kms East of the Saudi capital Riyadh, on June 16, 2013. FAYEZ NURELDINE—AFP/Getty Images

Saudi Arabia confirmed Tuesday an additional 113 cases of Middle East Respiratory Syndrome (MERS), dramatically raising the kingdom’s caseload to a total of 688.

Reuters reports that Saudi Arabia’s Health Ministry released the revised figures after officials conducted a deeper review of the nation’s medical records. In addition to the heavier caseload, officials raised the virus’ death toll by 48% from 190 to 282 known deaths.

“While the review has resulted in a higher total number of previously unreported cases,” read a statement from Tariq Madani, head of the ministry’s scientific advisory board, “we still see a decline in the number of new cases reported over the past few weeks.”

Saudi Arabia dismissed its Deputy Health Minister Doctor Ziad Memish on Tuesday, without elaborating on the reasons for his dismissal, Reuters reports. The sacking comes only six weeks after Health Minister Abdullah al-Rabeeah was fired amid rising MERS infection rates.

[Reuters]

TIME Infectious Disease

2 Hospital Workers Treating MERS Patient Show Virus-Like Symptoms

Ken Michaels
Ken Michaels MD talks at a Middle East Respiratory Syndrome (MERS) press conference at Dr. Phillips hospital on May 13, 2014 in Orlando, Florida. Reinhold Matay—AP

Flu-like respiratory symptoms have been seen in health care workers exposed to Middle East Respiratory Syndrome patient in Orlando, Fla. A total of 20 are being tested for the disease

Two health care workers at the Orlando, Fla. hospital treating a confirmed Middle East Respiratory Sydrome patient are showing symptoms associated with the virus.

Dr. P. Phillips Hospital, where the MERS patient is being treated, confirmed to TIME that two health workers are experiencing flu-like symptoms. One has been hospitalized, while the other is currently isolated at their home, and is being monitored. Neither has yet been diagnosed with MERS, the hospital said.

A total of 20 health care workers at Dr. P. Phillips Hospital are now undergoing testing for MERS after being exposed to the patient, the hospital confirmed to TIME. The virus is not a severe risk to the general public, but human transmission appears to happen among people who interact with those who are infected, typically in a health care setting.

Like the first patient in Indiana, the new patient lives in Saudi Arabia and is a health care worker there. The patient flew from Jeddah to London, and then to Boston, before traveling to Atlanta and finally Orlando to visit family. The patient started feeling ill during the flight from Jeddah to London, and had symptoms like fever, chills and a slight cough. The patient visited the emergency room at an Orange County hospital, and was isolated.

MERS is a respiratory virus that is in the same family as the common cold and Severe Acute Respiratory Syndrome (SARS). The disease appeared two years ago in Saudi Arabia, and to date, there are over 500 total cases, and over 100 deaths. The Center for Disease Control and Prevention (CDC) says the risk to Americans is extremely low, and there are currently no travel restrictions in place.

White House press secretary Jay Carney said earlier today that President Obama has been briefed on the two cases of MERS in the U.S, and that the White House is “watching this very closely.”

The MERS patient is Florida is said to be in stable condition, and the first patient in Indiana has already been discharged from the hospital.

TIME Saudi Arabia

Saudi Arabia Identifies 18 New Cases of MERS

A Saudi man wears a mouth and nose mask as he walks in a street of the Red Sea coastal city of Jeddah on April 27, 2014 AFP/Getty Images

There have been 449 cases of MERS in Saudi Arabia, which has seen the bulk of cases, and 121 people have died. In April, the number of cases in the country nearly doubled after outbreaks in hospitals.

Officials in Saudi Arabia said late Wednesday they have identified 18 new cases of Middle East Respiratory Syndrome (MERS) in the country, Reuters reports. The government also said four more people died of the disease Wednesday.

The new cases raise Saudi Arabia’s official number of MERS cases to 449, making it the country hardest hit by the deadly virus, which kills about a third of the people it infects. 121 people have died from the virus in Saudi Arabia, where the number of infections has surged since April amid outbreaks in hospitals in Jeddah and Riyadh.

MERS, a form of coronavirus similar to SARS, causes coughing, fever and pneumonia. It was first identified two years ago. Researchers have been largely stumped by the origin and transmission patterns of the virus, which some scientists have linked to bats and, increasingly, camels.

A case of the virus was confirmed in the United States for the first time earlier this month. Other cases have been reported in more than a dozen other countries, including Britain, France and Jordan.

[Reuters]

TIME Infectious Disease

Saudi Arabia Reports More MERS Deaths

Saudi Arabia reports three more deaths as cases continue to rise

Saudi Arabia’s death toll from MERS has hit 115.

The Associated Press reports that on Monday, a 45-year-old man and two women in their 50s died from MERS (Middle East Respiratory Syndrome) after contracting it in the western Saudia Arabia city Jiddah.

Three additional people now have the disease, health officials report, bringing the Saudi Arabian total to 414 confirmed cases — and just last week, the CDC reported the first case in the U.S. The U.S. victim was isolated right away, and doctors say he will likely be heading home soon. He is currently at Community Hospital in Munster, Ind. The patient lives in Saudi Arabia and works in a hospital. He was visiting family in the U.S. on a planned trip.

MERS is in the same virus family as SARS. It has no vaccine or treatment, and researchers believe the disease may have come from camels. So far, human-to-human transmission has only occurred among people with close contact with infected people.

There’s worry over how much the disease could spread in July when millions of people are expected to visit on Saudi Arabia for Ramadan. In October, millions of Muslims will also gather in the city of Mecca for the Hajj, an annual Islamic pilgrimage. Health officials are worried about transmission.

[AP]

 

TIME health

MERS Shows That The Next Pandemic Is Only a Plane Flight Away

SARS ravaged Hong Kong in 2003
A single patient seeded Hong Kong's SARS outbreak in 2003 Peter Parks—AFP/Getty Images

On Feb. 21, 2003, a 64-year-old Chinese physician named Dr. Liu Jianlun traveled to Hong Kong to attend a wedding. He stayed in room 911 on the ninth floor of the Metropole Hotel. Liu, who had been treating cases of a mysterious respiratory disease in the neighboring Chinese province of Guangdong, was already sick when he arrived in Hong Kong, and the next day he checked into the city’s Kwong Wah hospital. Liu died on Mar. 4 of the disease doctors soon named Severe Acute Respiratory Syndrome, or SARS. But before he died, he inadvertently infected at least 16 people who spent time on the ninth floor of that Hotel.

Some of those people boarded international flights before they knew they were sick, seeding new outbreaks in places like Vietnam, Taiwan and Singapore. SARS had been confined to southern China for months, but once Liu checked into the Metropole Hotel, it was only a matter of time before the first new infectious disease of the 21st century went global. Before it was stamped out months later, SARS had infected 8,273 people, killing 775 people in 37 countries.

It’s that chain of events that must have been on American officials’ minds last week when news broke that the U.S. had its first case of Middle East Respiratory Syndrome (MERS). A male health care provider had been in Saudi Arabia, the epicenter for the ongoing MERS outbreaks, before flying to Chicago via London on Apr. 24. After arriving in Chicago, he took a bus to the Indiana town of Munster, where on Apr. 28 he was admitted to the hospital and was eventually diagnosed with MERS. A deadly respiratory disease that has already infected hundreds, almost all in Saudi Arabia, and killed over 100 people had come to the U.S.

CDC officials played down the larger threat of the first U.S. MERS case. “In this interconnected world we live in, we expected MERS to make its way to the U.S.,” Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters on May 2. “We have been preparing for this.” CDC officials will contact and track individuals who might have been close to the patient — including health workers who treated him and fellow travelers on his international flights and his bus ride to Munster — just in case any developed MERS symptoms. That’s not likely. So far MERS hasn’t shown much ability to spread easily from person to person, so the threat to the larger U.S. public is probably very small.

But if that Indiana case remains isolated — and MERS itself never becomes the global health threat that SARS was — it only means we were lucky.

As Schuchat put it, exotic, emerging diseases are now “just a plane’s ride away.” In the past, before international air travel became common, emerging pathogens could begin infecting people but remain geographically isolated for decades. Scientists now think that HIV was active among people in Central Africa for decades before it really began spreading globally in the 1970s, again thanks largely to international air travel. Today there’s almost no spot on the planet — from the rainforests of Cameroon to the hinterland of China — so remote that someone couldn’t make it to a heavily populated city like New York or Hong Kong in less than 24 hours, potentially carrying a new infectious disease with them.

The surest way to prevent the spread of new infectious disease would be to shut down international travel and trade, which is obviously not going to happen. The occasional pandemic might simply be one of the prices we pay for a globalized world. But we can do much more to try to detect and snuff out new pathogens before they endanger the health of the planet.

Because most new diseases emerge in animals before jumping to human beings (the virus that causes MERS seems to infect humans mostly via camel, though bats may be the original source), we need to police the porous boundary between animal health and human health. That work is being done by groups like Global Viral (whose founder I profiled in November 2011) is creating an early warning system capable of forecasting and containing new pathogens before they fuel pandemics. But as the stubborn spread of MERS shows, that’s easier said than done — especially if diseases emerge in countries that have less than open political systems.

Because as it turns out, the driving factor behind the spread of new diseases isn’t just globalization. It’s also political denial. SARS was able to spread beyond China’s borders in part because the Chinese government initially covered up the outbreaks — at one point even driving SARS patients around Beijing in ambulances to hide them from an international health team. Meanwhile, the autocratic Saudi government has made life difficult for researchers studying MERS. Much the same thing happened when the avian flu virus H5N1 began spreading in Southeast Asia in 2004. In every case, a rapid and public response might have contained those viruses before they threatened the rest of the world.

Eleven years later Hong Kong’s Metropole Hotel is now called the Metropark, and Liu Jianlun’s infamous room 911 doesn’t exist any more. After SARS, hotel management changed the number to 913 in an attempt to scrub out the past. Denial is always so tempting. But in an interconnected world, where the travel plans of a single person can seed deadly outbreaks a continent away, it’s no longer an option.

TIME Saudi Arabia

Saudis Show Off a Missile As Tensions Rise With Iran

Saudi worries about a nuclear Iran may be behind display of a missile that could reach Tehran

Saudi Arabia bought its mid-range Dong Feng-3 ballistic missiles from China in the late 1980s, but had not put them on public display until they were wheeled past a reviewing stand at the Hafr al-Batin military base this week, at the parade concluding the largest military exercise the kingdom has ever mounted.

It was no secret that the Saudis had the missiles, but the public outing of the weapons on Tuesday was broadly interpreted by analysts as Saudi Arabia sending a message to its regional rival, Iran, at a time when the countries are battling at one remove in Syria, and the Saudis feel betrayed by Washington for attempting a rapprochement with Tehran by embracing negotiations on Iran’s nuclear program.

“They’ve been kept under wraps all these years, albeit they were known to be there; it’s just quite interesting for us to see them on show,” says Jeremy Binnie, editor of Jane’s Terrorism and Security Monitor, who was among the experts taking note of the Saudi showcase.

“I think there’s a few different ways you could potentially read it, but certainly one is as a sort of display of Saudi Arabia’s ability to retaliate in kind to Iranian ballistic missile attacks. And that was sort of the message coming out of this exercise in general, quite a lot of publicity by Saudi Arabia standards all round.”

The Saudis and Iranians are longtime rivals divided foremost by faith – the Saudis functioning as guardians of Islam’s dominant Sunni branch, while the Iranians lead the minority Shia denomination. But the competition has ramped up in recent years as Iran has drawn Iraq into its orbit (as the Saudis insistently warned Washington would happen if the secular Sunni dictator, Saddam Hussein, was brought down), and has sharpened as Iran has drawn nearer to the capability of producing a nuclear weapon.

Iran says it has never had plans to build a nuclear bomb. It is currently engaged in negotiations over its nuclear program with the United States and other world powers. Those talks are reportedly proceeding well of late. Which is small comfort to the Saudis. “They don’t have much faith in the Obama administration,” says Meir Javedanfar, a senior researcher at the Institute for Policy and Strategy at IDC Herzliya, a private Israeli university. “They are worried Washington is going to reach a deal with the Iranians and leave the Saudis behind.”

Hence Riyadh’s tough talk about going it alone. “We do not hold any hostility to Iran and do not wish any harm to it or to its people, who are Muslim neighbors,” Saudi Prince Turki al-Faisal, the former head of Saudi intelligence, told a security conference for Gulf states last week. “But preserving our regional security requires that we, as a Gulf grouping, work to create a real balance of forces with it, including in nuclear know-how, and to be ready for any possibility in relation to the Iranian nuclear file.”

Tehran routinely showcases its own arsenal in parades, as well as mounting war games several times a year. But at the Saudi base, the reviewing stand also conveyed a message: Among the dignitaries was the chief of Pakistan’s army, Gen. Raheel Sharif, whose presence, along with the missiles, could be read as a threat to top a Saudi missile with a Pakistani nuclear warhead. The Saudis reportedly aided Pakistan in its clandestine and successful nuclear effort, and have done little to quell reports that Islamabad might provide its loyal friend with a warhead should Iran actually produce an atomic bomb.

“You can read what you like into it,” says Binnie. “But having a high-ranked Pakistan guy there helps keep that idea alive that Saudi Arabia might be in a position to get nuclear warheads form Pakistan if Iran goes nuclear, which the Saudis want us to believe at the moment.”

Will the Iranians respond? Not on any parade ground, says Javedanfar,who lived in Iran in 1987.

“It is a flexing of the muscles, but the war being fought between Iran and Saudi Arabia is not one where you can use missiles,” he says. “It’s proxy war, where you can use your intelligence agents, you use terror, you use unconventional means. That’s why I don’t think this is going to impress the Iranians too much.”

What might impress Tehran, he says, is a bold move in Syria, the main proxy war between the two Middle East powers. Iran and its proxy, the Lebanese Shiite militia Hizballah, heavily support President Bashar Assad against rebels armed and supported by the Saudis and a handful of other majority-Sunni nations. “I don’t think either Iran or Saudi Arabia sees the other as a conventional threat,” says Javedanfar. “If we see a flooding of Pakistani weapons to the rebels in Syria, this is the kind of thing that will worry the Iranians, not a Saudi missile.”

TIME Saudi Arabia

Saudi Arabia Reports 4 More MERS Deaths

Asian workers wear mouth and nose masks while on duty during a football match at the King Fahad stadium, on April 22, 2014 in Riyadh.
Asian workers wear mouth and nose masks while on duty during a football match at the King Fahad stadium, on April 22, 2014 in Riyadh. The health ministry reported more MERS cases in the city of Jeddah, prompting authorities to close the emergency department at the city's King Fahd Hospital. Fayez Nureldine—AFP/Getty Images

Nearly 300 people have been infected so far, including a 65-year-old Turkish pilgrim in Mecca, a city to which millions of Muslims will make the Hajj later this year, worrying health experts about the virus's spread internationally

Saudi Arabia has reported four new deaths and 36 more infections within the last day from the Middle East Respiratory Syndrome (MERS), the Associated Press reports.

Among the newly infected is a 65-year-old Turkish pilgrim in Mecca, one of two cities where millions of Muslims from across the world will gather later this year for the Hajj, an annual Islamic ritual. Some health experts are concerned the gatherings will exacerbate MERS’ rapid spread to other countries.

Saudi Arabia has seen a spike in MERS infections in recent weeks, with many health workers among the sick and the dead. The Saudi Health Ministry says there have now been 297 cases and 85 deaths related to the virus since it first appeared in the country two years ago.

MERS is in the same family of viruses as SARS (Severe Acute Respiratory Syndrome) and the common cold. MERS has no vaccine or treatment. It’s unclear how the virus is being transmitted, though some scientists theorize that the virus may have spread from camels. The virus does not spread as quickly as SARS. It’s possible MERS will die out on its own, though some are worried it could mutate into a more easily-spreadable disease.

[AP]

TIME Saudi Arabia

Fears Rise Over MERS Outbreak While Saudis Fumble

The deadly Middle East Respiratory Syndrome has neither no definitive origin, nor a known cure, so global public health officials are becoming increasingly concerned by the Saudi government's sluggish response as the number of human cases continues to rise

The sudden spike in cases of Middle East respiratory syndrome, or MERS, in Saudi Arabia came soon after camel-racing events at the Jenadriyah Festival in Riyadh. That suggested the surge in the incurable coronavirus, which resembles pneumonia but is fatal to 1 in 3 who contract it, confirmed what scientists already knew of the disease: that camels seem to be reservoirs for the virus, and transmit it to humans more easily than humans do to one another.

But with the number of cases picking up, there are worries that may be changing. And if the virus has mutated to increased person-to-person contagion, it has potentially catastrophic implications for another annual festival: the yearly pilgrimage to Mecca and Medina known as hajj. More than a million Muslims from around the globe gather in the western Saudi cities during the first week of October, then return to their home countries, which last year numbered 188. In an age when international travel has dramatically exacerbated the spread of new viruses like SARS, virologists say the mounting concern is only too clear.

The worries are aggravated by the performance of the Saudi government, which has failed to confirm whether the virus is, in fact, mutating. The Saudis have either not performed tests that would reveal the changes, or have not shared them with international authorities, virologists complain. On Monday, Health Minister Abdullah al-Rabiah was fired amid mounting criticism of the kingdom’s handling of the budding crisis.

“It’s frustrating,” says Ian Mackay, an associate professor at the Australian Infectious Diseases Research Centre at the University of Queensland, who compared the Saudi handling of MERS with China’s response to the 2013 outbreak of bird flu. “With the H7N9 virus, China provided almost too much information. You worried about the privacy of some of the patients, given the level of detail that China was providing.

“But we’re seeing the complete opposite extreme in Saudi Arabia, where you can’t even get the sex of the patient in some cases,” Mackay tells TIME. “And the WHO doesn’t seem to be getting that information either.”

Indeed, the World Health Organization as good as confirmed it did not have the latest information from Riyadh in declining to comment on the outbreak on Tuesday afternoon. “Kindly be advised that we cannot comment on latest MERS figures since we do not have the latest case count,” the WHO’s media office says in an emailed reply to questions from TIME. “And we can only communicate and comment on the cases that we have been officially notified of by a member state, namely Saudi Arabia.”

Concerns that the virus may have mutated are focused on two clusters of cases among health care workers: one cluster is in Jeddah, the western Saudi city through which pilgrims pass en route to nearby Mecca. The other cluster is among paramedics in Abu Dhabi, in the United Arab Emirates.

Mackay, who noted the clusters in his blog, says he can see two possible explanations: “One is a fairly bad but widespread breakdown of infection control and prevention protocols” among the health care workers — that is, nurses or doctors failing to use gloves, surgical masks or other standard measures designed to prevent infection while working with a MERS patient. Such a breakdown would be possible even in a well-equipped and prosperous Gulf nation, Mackay noted, but for both outbreaks to take place at the same time “would be fairly coincidental.”

The other, more alarming possibility? “The other avenue is the virus has changed and become more easily transmitted between humans,” Mackay said.

That is cause for concern way beyond the Middle East. “When humans readily transmit to humans, that’s what will cause a worldwide outbreak,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told National Public Radio. “We are very concerned that … with what we’ve seen over the last two weeks … we may be at that point now.”

Whether the virus has, in fact, mutated dangerously cannot be known until the Saudis examine the genome of the latest samples of the virus and share the results. The WHO has said it is “working closely” with the kingdom, but has not issued any conclusions. Another way to find out if the virus has mutated would be if the number of cases were to skyrocket. But with only 344 cases worldwide so far — a decade ago, SARS infected at least 8,000, and killed 775 — the count remains low, and awareness is growing.

In 2013, concerns over MERS kept many as a million people away from hajj, an obligation that the Koran imposes upon any Muslim who can afford the trip. Saudi authorities discouraged attendance by the very young, the elderly, pregnant women, and people already suffering from chronic illness, a major risk factor for the virus. Still, more than 3 million people circulated at the holy sites for five days, at close quarters. With the risk of mass contagion in the air this year, the world may be hoping for a better reaction from Saudi Arabia than it has got so far.

Correction: The original version of this story misstated the name of the institution that scientist Ian Mackay belongs to. He works for the Australian Infectious Diseases Research Centre.

TIME Saudi Arabia

Saudi Arabia Confirms 20 New Cases of Deadly MERS Virus

SAUDI-HEALTH-MERS-VIRUS
Saudi medical staff leave the emergency department at a hospital in the center of Riyadh on April 8, 2014 Fayez Nureldine—AFP/Getty Images

About 49 people have been infected in the past six days by the incurable Middle East Respiratory Syndrome virus, which has claimed 76 lives in Saudi Arabia. The country's Health Minister said he did not know the cause of the sudden rise in cases

Saudi Arabia’s Health Ministry this weekend confirmed 20 new cases of the deadly Middle East Respiratory Syndrome, or MERS. All told, the MERS virus has infected 244 people in Saudi Arabia, with 49 confirmed cases in the past six days alone.

Of the 244 infected people in total, 76 have died, Reuters reports. MERS has no known cure and kills approximately a third of the people it infects.

Saudi Arabia’s Health Minister Abdullah al-Rabia said on Sunday he did not know the cause of the sudden rise in cases. He said there was no current need for extra precautionary measures like travel restrictions.

Authorities say the disease, which scientists have linked to camels and is similar to the SARS virus, does not spread easily from person to person and could die out on its own. However, some experts have warned that the virus could mutate, allowing for easier human-to-human transmission.

[Reuters]

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