The United Arab Emirates (UAE) yesterday reported three Middle East respiratory syndrome coronavirus (MERS-CoV) cases in one young family, including a pregnant woman. That report came 4 days after Qatari officials revealed that the virus was found in three camels with links to two human case-patients.
The World Health Organization (WHO) said today that the UAE cases involved a 38-year-old man, a 32-year-old woman, and their 8-year-old son. Media reports said the three were from Jordan, but the WHO statement did not list their nationality. A report today in the UAE newspaper The National said the mother has died of her illness.
The report from Qatar marks the second time the virus has been found in camels, the previous instance having been reported by Saudi Arabia about 3 weeks ago. But scientists have not yet found conclusive evidence that camels are a source of human infections.
UAE family cluster
The earliest onset of illness in the UAE cases was Nov 15, the WHO said. The parents were in critical condition yesterday, while their son had mild respiratory symptoms. The mother gave birth to a child while she was hospitalized for treatment, the agency said.
The three patients had no recent travel history, no contact with other known case-patients, and no recent contact with animals, the agency said.
The 8-year-old's infection was found through an epidemiologic investigation of the parents' contacts, and he is isolated in a hospital. Further investigations of the family's close contacts, the newborn baby, and healthcare workers are continuing, the WHO said.
The death of the 32-year-old mother was reported today by the Health Authority Abu Dhabi, according to The National. The story gave no other new details.
The WHO in today's statement also reported that two other Qatari MERS patients, whose cases were announced earlier, died on Nov 19 and 29, but it gave no details about the patients. A media report on Nov 19 had noted the MERS-CoV-related death of a 61-year-old man who was a foreign visitor in Qatar.
The WHO's MERS-CoV count now stands at 163 confirmed cases and 70 deaths.
Qatari officials reported the infected camels in a statement dated Nov 27, and the WHO followed up with its own statement Nov 29.
The WHO said the camel infections were found during the investigations of two human cases in Qatar, both in October. One involved a 61-year-old man who owns a farm and had significant contact with camels, sheep, and hens. The other case involved a 23-year-old man who worked in the other patient's barn. Qatar's Supreme Council of Health (SCH) said both of those patients recovered.
The WHO said the three infected camels were among a herd of 14 that were tested in the investigation of the human cases. All the camels seemed healthy or showed only mild signs of illness when samples were collected for MERS-CoV testing, and their status didn't change during their ensuing 40 days in isolation, the agency said.
Dutch scientists who helped with the investigation detected MERS-CoV RNA in nose swabs from the three camels tested, and they confirmed the result by sequencing a fragment of the virus, according to a Nov 29 ScienceInsider report.
All contacts of the two patients, along with another worker in the barn, tested negative for the virus, the WHO reported. The epidemiologic investigation was conducted by Qatari authorities with help from an international team assembled by the WHO and the United Nations Food and Agriculture Organization.
"These results demonstrate that camels can be infected with MERS-CoV but there is insufficient information to indicate the role camels and other animals may be playing in the possible transmission of the virus, including to and from humans," the WHO said.
The SCH is working with the Netherlands' National Institute for Public Health and the Environment and with Erasmus Medical Center to test samples from other animals and the environment of the barn, the WHO added.
The SCH statement said Qatar's Public Health Department and Department of Animal Resources "are conducting a national survey to investigate the presence of virus in animals, humans, and the environment, and the potential modes of transmission and exposure to the virus among humans who are in close contacts with animals." It recommended that any animals that have had contact with human case-patients should be isolated and tested.
The WHO also warned that people at risk for severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barns where the virus may be circulating. Others are advised to use general hygiene measures in such settings.
Previous camel finding in Saudi Arabia
The first report of a camel infected with MERS-CoV came from Saudi Arabia on Nov 11. Investigators tested the camel in connection with a MERS case in a 43-year-old man from Jeddah, who owned animals.
The Saudi Ministry of Health vowed to isolate the camel virus and compare its genome with that of the virus in the camel's owner. If the isolates were identical, it would increase the likelihood that the camel was the source of the human infection. But Saudi officials have not yet reported results of the sequencing.
Studies published in recent months showed that camels in Oman, Egypt, and the Canary Islands carried antibodies to MERS-CoV or a closely related virus, but the virus itself had not been found in a camel or any other animal until the discovery in Saudi Arabia.
The WHO, in a Nov 22 summary of MERS-CoV developments, observed that all four of the recent MERS-CoV cases in Qatar involved people who had contact with farm animals.
However, the agency also said that most of the sporadic MERS-CoV cases—those not linked with any other previous cases—involved patients with no history of exposure to camels.
In other developments, the WHO announced today that its emergency committee on MERS-CoV will hold its fourth meeting on Dec 4. The panel, convened under the International Health Regulations, declared at its previous meetings that the disease did not yet constitute an international public health emergency.
Dec 2 WHO update on cases in Abu Dhabi
Dec 2 The National story
Nov 29 WHO statement on Qatar camel infections
Nov 27 Qatar Supreme Council of Health statement
Nov 29 ScienceInsider story