WHO raises its MERS-CoV count to 55 cases, 31 deaths

The World Health Organization (WHO) today updated its global count of Middle East respiratory syndrome coronavirus (MERS-CoV) cases to 55, including 31 fatalities, by including a previously reported Saudi case as the country reported a new one.

Also, the index MERS patient in Italy has been released from the hospital, according to a local media report. And a US legal expert weighed in on issues surrounding "ownership" of MERS-CoV as another report detailed frustrations that US scientists have over obtaining samples from Saudi Arabia that they collected in October.

The WHO confirmed the fatal MERS case in an 83-year-old man that Saudi Arabia's Ministry of Health (MOH) first announced on Jun 4. The MOH at that time, however, did not say the man had died.

Yesterday on its MERS-CoV overview page, the agency updated the country's death toll by 1, to 25, without offering any details, while keeping the Saudi case count at 40. That change may have reflected the man's death.

The 83-year-old had unspecified underlying medical conditions and became ill on May 27. He died May 31. He is from Al-Ahsa, home to a hospital outbreak that has involved 22 cases and 10 deaths. The MOH did not say whether his case was part of that cluster.

In addition to Saudi Arabia, lab-confirmed MERS cases have been reported in Jordan, Qatar, the United Arab Emirates, France, Germany, Italy, Tunisia, and the United Kingdom.

"Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns," the agency said in its update.

The WHO on Jun 5 updated its MERS-CoV risk assessment but continued to not recommend travel restrictions, saying that travelers should take steps to lower their risk of infection, such as avoiding contact with people who have respiratory infections and washing hands frequently.

In related news, Saudi Arabia reported the death of an 81-year-old Saudi woman from MERS-CoV "at a hospital in Al-Ahsa in the Eastern Province," Arab News said today.

The woman was admitted to the hospital during the second week of May, the story said but did not specify when she died. A source said the woman did not want to be admitted to the hospital because it was associated with MERS cases, indicating that it was the hospital involved in the 20-case cluster.

In Italy, meanwhile, the index MERS patient in that country, whose case was first reported May 31, was released from the hospital last night, La Nazione reported today.

The patient, age 45, his 2-year-old niece, and a 42-year-old coworker are all home and doing well, the story said.

Legal issues

In an article in Foreign Affairs today, Indiana University's David P. Fidler, JD, an expert in international law and global health, said that restrictions imposed by Erasmus University's material transfer agreement (MTA) on the MERS-CoV are not out of the ordinary and haven't seemed to impede research.

Though he wrote that "Sorting through these claims and counterclaims proves difficult because facts are missing," Fidler said that the MTA between Erasmus (in the Netherlands) and the University of North Carolina—the only MTA made public—"do not seem unusual compared with those in other agreements governing the sharing of biological samples. Moreover, Erasmus is not the only source of MERS virus."

He also writes that arguments from the nongovernmental Third World Network that labs might be able to access the virus but don't want to out of fear that any work done might later be challenged as infringement of patent claims don't hold much water.

"Complaints would carry more weight if Saudi Arabia could show how, when, and in what circumstances the patent application has impeded its efforts," he wrote.

Fidler also addresses the issue of information sharing under International Health Regulations and the broader topic of virus ownership and calls out Saudi Arabia several times for its lack of openness in the outbreak.

He concludes by saying that the controversy over virus ownership and use highlights the fact that, except for influenza, no clear international rules on sharing samples exist.

"It is premature to conclude that a new global framework is needed," Fidler said. "Instead, the focus should be on figuring out what exactly has hindered responses to MERS thus far, including problems Saudi Arabia has caused or experienced, and addressing them."

Saudi delays

In an ironic twist, researchers with the US Centers of Disease Control and Prevention (CDC) expressed frustration over Saudi MTA-related roadblocks, according to a Canadian Press story today.

The CDC scientists have been trying to obtain samples they collected on a trip to Saudi Arabia last October. But the specimens have been tied up because the Saudis have insisted that the CDC sign an MTA, the story said.

Mark Pallansch, PhD, director of the CDC's division of viral diseases, said the delay is unusual for an MTA but would not comment on what has held up negotiations.

"We are told at this point that we are close," Pallansch said. "So I do have some degree of hope that we will indeed have this completed in the near future."

Fidler also expressed surprise at the delay. "The fact that negotiations are still going on about an MTA . . . is very surprising," he told the Canadian Press.

See also:

Jun 7 WHO update

 Jun 5 updated WHO risk assessment

 Jun 7 Arab News story

 Jun 7 Google-translated La Nazione report

 Jun 7 Foreign Affairs article

 Jun 7 Canadian Press story

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