WHO sets up emergency panel for guidance on MERS

The World Health Organization (WHO) is setting up an emergency committee of experts to provide guidance on dealing with MERS-CoV (Middle East respiratory syndrome coronavirus) in case the disease starts to spread more widely, a senior WHO official announced today.

In addition, the WHO today announced two new MERS cases in Saudi Arabia and noted the deaths of two Saudi patients whose cases had been announced earlier. These events raised the agency's global MERS tally to 79 cases and 42 deaths.

The new cases are in two men, aged 66 and 69, both from Riyadh, the WHO said. Both were hospitalized Jun 28 and are in critical condition in an intensive care unit. The agency's statement did not say whether the men are related or otherwise connected.

The two deaths, which Saudi Arabia had announced on Jul 2, involve a 63 year-old woman from Riyadh and a 75 year-old man from Al-Ahsa, the agency said.

Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, announced the formation of the emergency committee at a press conference in Geneva today. The agency posted a recording of the briefing.

"We've been discussing this a fair amount and what we've decided at WHO is to go ahead next week and convene an International Health Regulations emergency committee," he said. "We really want to be in position to be ready for any possibility, and we want countries to be ready for any possibility."

"This allows the director-general and WHO to receive input from an external group of experts, so we'll get formal consultation and information coming in," Fukuda said. "If we see some future explosion or outbreak, we'll already have a group of emergency committee experts who are already up to speed. We just want to make sure we can move as quickly as possible if we need to move in the future in any major direction."

He described the step as a proactive move, because there's no "acute emergency" with regard to MERS. The pattern of cases has been fairly steady over the past 3 months, with 19 in April, 21 in May, and 22 in June, he said.

The names of the emergency committee members will be announced Jul 8, and plans call for the group to confer by phone on Jul 9 and again on Jul 11, Fukuda said.

The WHO will provide the panel with a review of the MERS situation, he said. The affected countries will provide information to the group directly, and the committee members will have an opportunity to ask questions.

"Once the committee feels pretty grounded, we'll ask them if they think the situation constitutes a public health emergency of international concern," he noted.

The new committee is the second emergency panel the WHO has set up under the International Health Regulations (IHR), the current version of which took effect in 2007. The first time the WHO took the step came during the 2009 H1N1 influenza pandemic, Fukuda explained.

In background comments, Fukuda said the WHO sees two main patterns of MERS cases: sporadic cases in communities, from sources unknown, and cases resulting from person-to-person transmission among close contacts, mostly in families and hospitals.

"You might characterize the picture as a patchwork of local infections, some sporadic and some from person-to-person transmission, without a big sweeping through countries or communities," he said.

In response to questions, Fukuda said the WHO is not contemplating recommending any travel restrictions in connection with MERS and the upcoming Hajj, which will draw throngs of religious pilgrims to Saudi Arabia in October.

Trying to disrupt or slow travel creates "another set of stresses and concerns," he said. In view of the current pattern of cases, he continued, "The advice we've been giving to Saudi Arabia and other countries is that we don't think we should try to disrupt or slow travel at this point. We've told countries to work with their medical communities so they know about this infection."

In other responses to questions, Fukuda said the Saudis have generally done a good job of responding to MERS. He cited the government's work in sending teams into communities, investigating hospital outbreaks, stepping up infection control precautions in hospitals, and providing information to the Saudi public. (Saudi government statements about MERS cases have been sketchy, and many observers have complained that the government has released too little information about the situation.)

"I'd like to see more detailed information about the overall situation," Fukuda said. "I think that this is not so much a Saudi-specific issue for me as it is a request across the entire scientific community to get as much information as possible."

In other moves, the WHO today released detailed guidelines for investigating MERS cases. That comes 2 days after the agency released similarly detailed guidance for conducting case-control investigations to try to find the source of the virus, which remains a mystery.

The purpose of the new guidelines is to provide a standardized approach for public health authorities and others to investigate both probable and confirmed MERS cases. It says that most of the advice applies primarily to countries where infection is assumed to have come from an animal source and where the exposures that lead to infection remain the critical question.

In other MERS-CoV news, French researchers published a modeling study suggesting that the virus does not currently have the potential to spark a pandemic. Their report appears today in The Lancet.

On the basis of MERS cases and data reported through early June, the team estimated that the basic reproduction number for the virus—how often the virus can spread from one person to another—ranges from 0.60 to 0.69, well below the 1.0 it would take to confer pandemic potential, the report says.

"Our analysis suggests that MERS-CoV does not yet have pandemic potential," the authors conclude. "We recommend enhanced surveillance, active contact tracing, and vigorous searches for the MERS-CoV animal hosts and transmission routes to human beings."

The authors and other experts warned that the virus could well change and become more transmissible, according to a Canadian press (CP) report today.

"There is absolutely no guarantee that this virus will stay as it is. It could very well follow the same path as SARS [severe acute respiratory syndrome] did 10 years ago," Arnaud Fontanet, PhD, of the Institut Pasteur in Paris, senior author of the study, told the CP.

See also:

WHO page for accessing press conference recordings

Jul 5 WHO statement on new cases

WHO information about emergency committees under IHR

Jul 5 WHO guidance for investigating MERS cases

Jul 5 Lancet abstract

Jul 5 CP story

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