Despite a fairly steady trickle of cases since mid-July, a World Health Organization (WHO) advisory committee today reaffirmed its earlier finding that the status of Middle East respiratory syndrome coronavirus (MERS-CoV) does not currently represent a global public health emergency.
The committee reiterated the need to strengthen case surveillance and investigative work concerning MERS, but it did not issue any new travel warnings or guidance beyond recommendations made in July. The annual Hajj pilgrimage is expected to draw millions to Mecca, Saudi Arabia, in October.
The panel, convened under the International Health Regulations (IHR), made its decision after hearing an update on the MERS-CoV situation from the WHO and health officials from Saudi Arabia and Qatar, two of the affected countries, said Keiji Fukuda, MD, the WHO's assistant director-general for health security and the environment.
"The bottom line is that after hearing all the information, they affirmed their assessment from July that the conditions for a public health emergency of international concern have not been met," Fukuda said at a press teleconference.
The WHO panel issued its earlier assessment of the MERS situation on Jul 17, calling it "serious and of great concern," but not an international emergency. The group felt that declaring an emergency would have been disproportionate and could've done more harm than good, Fukuda said at the time.
Today Fukuda said 47 MERS cases have been confirmed since the WHO panel's July announcement, raising the agency's global count to 130 confirmed and 17 probable cases. No cases have been reported outside the Middle East since that time, he observed.
The case-fatality rate is about 42%, and 64% of cases have involved men, Fukuda said. The median age of patients is 50.
As the WHO has said previously, cases fall into two groups: people in communities getting infected by unknown sources, and secondary cases linked to those sporadic ones, he said.
"Over the past 4 or 5 months we've seen a steady stream of cases," he said. "We don't know if we're going to see a seasonal pattern."
While not calling for an emergency declaration, the WHO panel advocated beefing up the response to MERS-CoV. According to a WHO statement, the group stressed the importance of:
- Increased surveillance, especially in countries with pilgrims participating in the Hajj
- Increasing awareness and risk communication efforts
- Supporting vulnerable countries, especially those in sub-Saharan Africa
- Increasing diagnostic testing capacities
- Continuing investigations, including case-control studies, to find the source of the virus and how people are exposed
- Sharing information promptly, in accordance with the IHR
In late July the WHO advised that people with chronic medical conditions should talk with their physician before going on a pilgrimage to Saudi Arabia, which, for its part, has advised the elderly and chronically ill not to make the trip this year. The WHO also offered advice at the time on what travelers should do if they got sick while in Saudi Arabia or after returning home.
Fukuda said the committee saw no reason to offer any new travel guidance at this point.
He said some countries that have pilgrims returning from Saudi Arabia are conducting surveillance for possible MERS cases, but "the levels of surveillance are really suboptimal in a number of countries that may be at risk for infections."
In response to questions, Fukuda shed little light on the MERS-CoV response by Saudi Arabia, which has been accused of withholding information about MERS and not doing enough to investigate it.
He said the committee had a general discussion of the need for timely sharing of information, but did not get into specific instances. Similarly, the group talked generally about the need for case-control studies to try to figure out how people are exposed to the virus, but the Saudi Arabian representative who briefed the group did not talk about such studies, Fukuda reported.
When Fukuda was asked specifically to comment on Saudi Arabia's approach to MERS-CoV, he said, "Usually I refrain from commenting on specific countries' behaviors or actions. We've been in close contact with the Kingdom of Saudi Arabia, and we know that they've done extensive efforts both to investigate cases and get a better handle on how people are being infected."
He added that the WHO has provided "essentially all the information we have from countries that have provided it," holding back only details that could reveal personal identities.
When Fukuda was asked why MERS-CoV is still so mysterious a year after it was identified, he said the world is impatient for information whenever a new virus emerges and that this impatience has increased with time.
"The bottom line is that a lot of the studies, things such as case-control studies, understanding what are real exposures or risk factors, are not easy studies to do," he said.
In other developments, the family of a Saudi Arabian man who recently died of MERS said he had had contact with a sick camel shortly before he got sick, according to a Wall Street Journal (WSJ) story yesterday.
The story said that Fahd al-Sahly, a government employee and part-time camel trader in Hafr al Batin, bought a young camel in early August, according to his brothers. When the camel fell ill, with watery fluid streaming from its nostrils, Sahly treated it as best he could and then sold it, the brothers said. Three days later, Sahly got sick, and he died 10 days after that, the family said.
Camels in Oman, Egypt, and the Canary Islands have been found to have antibodies to MERS-CoV or a closely related virus, but they have not been shown to harbor the virus itself.
Fahd al-Sahly's mother and two other family members also succumbed to MERS-CoV, the family told the WSJ. Family members said they had never heard any warnings about the disease.
Sep 25 WHO statement on third meeting of IHR MERS committee
Jul 17 CIDRAP News story on initial committee announcement
Jul 25 CIDRAP News story on WHO travel recommendations
Sep 24 WSJ story