May 21, 2013 (CIDRAP News) – A World Health Organization (WHO) expert has expressed concern that guest workers in the Middle East could carry the Middle East respiratory syndrome coronavirus (MERS-CoV) to India and the Philippines, according to a media report, while a few more details emerged about three Tunisian cases reported yesterday.
Anthony Mounts, MD, the WHO's technical lead for MERS-CoV, said guest workers could bring the virus to their home countries, where it might spread widely before being detected, according to a report in the Toronto Star.
Meanwhile, another WHO official, Gregory Hartl, revealed today that because of "sample issues," the fatal MERS-CoV case reported yesterday in a 66-year-old Tunisian man was not confirmed, only suspected. He said cases in the man's two children were confirmed; press reports said those patients have recovered.
The cases reported yesterday are Tunisia's first. The older man, a diabetic, fell ill after returning from a trip to Saudi Arabia and Qatar. A Tunisia Live story today said he died May 10 but that his daughter and son recovered quickly with treatment. Other reports referred to the man's children as two sons.
Hartl said via Twitter that the global count of confirmed MERS-CoV cases stands at 43, with 21 deaths. He also commented that the Tunisian cases resemble the pattern seen earlier in the United Kingdom and France: an imported case, followed by limited human-to-human transmission.
Mounts, in the Star interview, called the virus's spread from the Middle East to other countries a "real concern."
"There are a lot of workers from the Indian subcontinent and the Philippines working in the Middle East—people are also going back to some of these areas where there may not be the same facilities for picking up cases," he said. "So my concern is that there may be travelers who are taking this back to Karachi or to Delhi or to Mumbai or Manila who are not being detected and you could have local transmission in those settings and it wouldn't be discovered until it's spread quite far."
The Saudi Arabian government has been criticized for its response to MERS-CoV, particularly with regard to information sharing. But Mounts was generally positive about the Saudi response, according to the Star.
A group of WHO experts who recently visited Saudi Arabia to help investigate the situation "were actually fairly reassured that everything is being done that possibly could be done to investigate the causes of this outbreak and try and find the source," he said.
Referring to a recently reported case cluster in a hospital in Saudi Arabia's Eastern province, Mounts said the ministry of health and the hospital "instituted some measures that seem to be stopping the transmission that was occurring in the hospital. So that was reassuring." Officials have reported 22 cases in the hospital-centered outbreak.
Regarding complaints that Saudi Arabia hasn't been sufficiently open about the MERS-CoV situation, Mounts said officials there "feel a little bit like they're drinking from a fire hose—it's just a huge amount of information that they've been collecting in a very short period of time and they just haven't had the time to completely analyze and put it all together in summaries."
He said further that the Saudis have shared information when asked and have reported new cases when they occur, as required by the International Health Regulations. But he said the WHO needs to know more about what kind of exposures are causing people to get infected.
"The Saudis are giving us information," he said. "We would like more of it. Hopefully we're working a bit more closely with them during the World Health Assembly and helping them understand what we need. I think that they're starting to wrap up some of their early investigations; I'm hoping some of that information will become available very soon."
In other developments today, a Canadian infectious disease specialist who recently visited Saudi Arabia to help investigate the hospital-centered MERS-CoV outbreak there said the outbreak is complex and analyzing it will take time, according to a Canadian Press report.
Allison McGeer, MD, head of infection control at Toronto's Mount Sinai Hospital, said she understands people's frustration about the lack of information on MERS-CoV. But she said, "The only thing worse than not sharing data is sharing data that turns out to be not correct. And this is a very complicated investigation. It's not simple. The answers are and were not completely clear."
McGeer said a report on the outbreak is being written.
May 21 Toronto Star story
May 21 Tunisia Live story
May 21 AP story on Tunisia cases
May 21 Canadian Press story