WHO confirms MERS in Iran as Kuwait finds virus in camels

The World Health Organization (WHO) today confirmed the first two MERS-CoV cases in Iran, reported recently in the news media, while another media story said Kuwait has found the virus in five camels.

Also, Saudi Arabia reported no new MERS-CoV (Middle East respiratory syndrome coronavirus) cases or deaths today, for the second day in a row.

Meanwhile, a ScienceInsider report unveiled the circumstances underlying two recent scientific papers that deal with MERS-CoV in the same Saudi Arabian patient and his camels. The story describes a dispute between Saudi Ministry of Health (MOH) scientists and a Saudi university group and raises questions about the findings of the latter.

Both Iranian patients still alive

In confirming the MERS cases in two Iranian sisters, the WHO said both patients are still alive, which contradicts a May 30 media report that said one of them had died. The agency said Iranian officials informed it of the cases on May 26.

The two women, ages 52 and 50, both have underlying conditions and fell ill on May 11, the WHO reported. The older one was hospitalized the same day and is in critical condition. She had not traveled, had contact with animals, or consumed raw camel products before her illness, but she had close contact with another woman who had traveled to Saudi Arabia for the Umrah pilgrimage and had an influenza-like illness.

The younger sister was hospitalized on May 17 and is in stable condition, the WHO said. She had close contact with her sister before her illness, but like her, had not traveled or had any exposures to camels or other animals. The women live in Kerman province.

Iranian health authorities are monitoring all of the two patients' close contacts, the agency said. In addition, some control measures have been established at the hospital where they are being treated.

The two cases raised the WHO's global MERS count to 683 cases and 204 deaths. The number includes 44 cases that Saudi Arabia reported to the WHO between May 19 and Jun 2. The agency did not mention the 113 cases, with 92 deaths, that Saudi officials reported belatedly on Jun 3. Details on those cases are still awaited.

Infected camels in Kuwait

Word of MERS-CoV infections in five camels in Kuwait came in a terse news story yesterday from the Kuwait News Agency (KUNA). It appears to be the first report of infected camels in the country.

Jassem Al-Bader, head of Kuwait's Public Authority for Agriculture Affairs and Fish Resources, announced the camel findings, the story said. The infections were found "among 83 diagnosed specimens," and the camels' owners have been told to isolate the animals, it said. The story gave no other details about the camels.

A post on ProMED, the outbreak reporting service of the International Society for Infectious Diseases, said that if the news is confirmed, Kuwait will become the fifth country on the Arabian Peninsula to find MERS-CoV in camels, following Qatar, Oman, Saudi Arabia, and the United Arab Emirates.

In related news, officials in Qatar found evidence of past MERS-CoV infection in five camels, according to a report they filed with the World Organization for Animal Health (OIE) on Jun 9. The finding involves the same farm where a human MERS-CoV case was identified last October and where three infected camels were identified.

The new report said "seroneutralization tests" conducted in the Netherlands were positive for 5 of 12 camels, implying that they had antibodies to MERS-CoV or a similar virus. No camels died, and apparently none had symptoms, as the report cited "asymptomatic exposure of camel to MERS-CoV."

Comments included in the report mention the collection of camel milk samples, but it doesn't make clear whether the milk samples were tested.

On Jun 5 a Gulf Times story described a Qatari national survey that showed that MERS-CoV RNA was found in more than half of milk samples from camels that were shedding the virus. The survey also revealed that MERS-CoV antibodies were found in all camel milks samples, the story said.

Duplicate studies

The ScienceInsider story deals with two recent papers that both describe a MERS patient in Jeddah, Saudi Arabia, who owned camels infected with MERS-CoV, suggesting that he caught the virus from them.

One was published Mar 20 in Emerging Infectious Diseases (EID) and lists Ziad Memish, MD, former Saudi deputy health minister, as lead author. The other paper was published last week in the New England Journal of Medicine (NEJM) and included Tariq Madani of King Abdulaziz University in Jeddah as senior author. Madani recently became the Saudi government's chief scientific adviser on MERS.

Madani told Science that the infected Jeddah man was his patient and that he was the first to send a team to investigate at the patient's farm. He also said he notified the Saudi MOH at the time of his suspicion that camels might have been the source of the virus.

Memish told Science that the MOH then conducted its own investigation of the case before announcing on Nov 11 that a camel was the likely source of the man's infection. He said no physicians were authorized to interfere with the MOH investigation or investigate on their own without coordinating with the ministry.

The Memish study reported that sequencing of about 15% of the genome of a MERS-CoV isolate from one of the camels showed that it was almost identical to the virus from the patient, the story notes.

Madani's team reported that they sequenced the full genomes of both the human and the camel isolates and found that they were 100% identical. But several scientists, according to ScienceInsider, are raising doubts about that finding on technical grounds.

In an e-mailed statement this week, NEJM, which published Madani's paper, said, "There is substantive difference between the June 2014 NEJM article and the Emerging Infectious Diseases article published online in March. The NEJM article includes a clinical description, as well as laboratory, serologic, and virologic data. There is no author overlap between the articles.

"NEJM editors were not aware of the EID article prior to our publication. Had they been aware, they would have requested an acknowledgement in the NEJM article. To address this matter, we have appended an editor's note to the NEJM article."

Ian Mackay, PhD, a virologist at the University of Queensland in Australia, told ScienceInsider that the case is another example of the complex politics of MERS research in Saudi Arabia. "It typifies what MERS has been all about: very poor communication," he said.

See also:

May 27 CIDRAP News story on Iranian cases

Jun 10 KUNA story

Jun 9 OIE report by Qatar

Jun 11 ProMED post on infected camels

Jun 10 ScienceInsider story

Jun 4 CIDRAP News story on NEJM report

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