MERS outbreak

The 2012 Middle East respiratory syndrome coronavirus outbreakrefers to the first ever outbreak of a novel betacoronavirus first identified in a patient from Saudi Arabia.

Epidemiology

MERS cases and deaths, April 2012 – present
Country or Region	Cases	Deaths	Fatality (%)
Oman	2	2	100%
France	2	1	50%
Italy	1	0	0%
Jordan	2	2	100%
Qatar	9	3	33%
Saudi Arabia	127	53	41%
Tunisia	3	1	33%
UAE	6	2	33%
UK	3	2	67%
Kuwait	2	0	0%
Total	157	66	42%
Source: CDC

On 21 February 2013, WHO stated that there had been 13 laboratory-confirmed cases, 6 cases (4 fatal) from Saudi Arabia, 2 cases (both fatal) from Jordan, 2 cases from Qatar, and 3 from the UK. Most infections with human coronaviruses are mild and associated with common colds. Some animal and human coronaviruses, like MERS-CoV, may cause severe and sometimes fatal infections in humans. MERS-CoV does not have many of the grave characteristics of SARS-CoV (severe acute respiratory syndrome) which caused fatal epidemics in southern China, Hong Kong and Canada in 2002 and 2003. Fortunately, global surveillance of potential epidemics and preparation has improved since and because of the SARS epidemic. In November 2012, Dr. Zaki sent a virus sample to confirm his findings to EMC virologist Ron Fouchier, a leading coronavirus researcher at the Erasmus Medical Center in Rotterdam. The second laboratory-proven case was in London confirmed by the UK Health Protection Agency (HPA). The HPA named the virus the London1_novel CoV 2012. On 8 November 2012 in an article published in the New England Journal of Medicine, Dr. Zaki and co-authors from the Erasmus Medical Center, published more details, including a scientific name, Human Coronavirus-Erasmus Medical Center (HCoV-EMC) which was then used in scientific literature. In the article, they noted four respiratory human coronaviruses (HCoV) known to be endemic: 229E, OC43, NL63, and HKU1. In May 2013, the Coronavirus Study Group of the International Committee on Taxonomy of Viruses adopted the official designation, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which was adopted by the World Health Organization to "provide uniformity and facilitate communication about the disease" to replace the unscientific designations Novel coronavirus 2012 or simply 'novel coronavirus' which were consistently used by WHO since 2012.

10 of the 22 people who died and 22 of 44 cases reported were in Saudi Arabia and over 80% were male. This gender disparity is thought to be because most women in Saudi Arabia wear veils that cover the mouth and nose, decreasing their chances of being exposed to the virus. As of 19 June 2013, MERS had infected at least 60 people with cases reported in Jordan, Qatar, Saudi Arabia, the United Arab Emirates (UAE), Tunisia, Germany, the United Kingdom (UK), France and Italy. The death toll had risen to 38. Saudi officials have expressed great concern that when the Hajj, or pilgrimage to Mecca, occurs this Autumn, millions of Muslims from around the world may potentially be exposed to the virus from being in crowded streets around the Kaaba.

Jordan

In April 2012, six hospital workers were diagnosed with acute respiratory failure of unknown origin. Of the six, two died. All the cases were reported to the European Centre for Disease Prevention and Control (ECDC). After Dr. Zaki isolated the nCoV strain, a trace back was done. Epidemiologists discovered the Jordan cases. Using stored laboratory samples for all six, it was found that samples from the two patients who had died tested positive for nCoV.

Oman

On 31 October 2013, the WHO confirmed that one person in Oman has MERS. The WHO said "the patient in Oman is a 68-year-old man from Al Dahkliya region who became ill" on October 26, 2013.

Saudi Arabia

The first known case of a previously unknown coronavirus, was identified in a 60-year-old Saudi Arabian man with acute pneumonia who died of renal failure in June 2012. As of 12 May 2013, two more deaths have been reported in the al-Ahsa region of Saudi Arabia. In the latest cluster of infections, 15 cases had been confirmed, and nine of those patients had died. Ten of the 22 people who died and 22 of 44 cases reported were in Saudi Arabia. An unconfirmed case in another Saudi citizen, for which no clinical information was available, was also reported around this time. On 22 September 2012, the Saudi Ministry of Health (MOH) announced that the two cases involving Saudi citizens, caused by what they termed a “rare pattern of coronavirus,” had both proven fatal.

Two of the Saudi Arabia cases were from the same family and from that family at least one additional person presented similar symptoms but tested negative for the novel coronavirus.

In March 2013, the Saudi Arabia Ministry of Health reported the death of a 39-year-old man, the 15th case and 9th death reported to WHO. On 2 May 2013, the Saudi Ministry of Health announced five people died and two other people were in critical condition with confirmed cases of a SARS-like virus. The delays in obtaining data and absence of basic information (which would usefully include: sex, age, other medical conditions and smoking status) have been noted and decried by Dr. Margaret Chan and in Pro-Med comments on numerous briefings. At the annual meeting of the world’s health ministers, Dr. Chan, director-general of the World Health Organization, said the virus was now her “greatest concern.”

On 28 May 2013, the Saudi Ministry of Health reported five more cases of MERS-CoV. The cases have been "recorded among citizens in the Eastern Region, ranging in age from 73 to 85 years, but they have all chronic diseases." With this announcement, the unofficial global case count reached 49 while the death toll stands at 24 according to the CDC. As of 26 June, 34 deaths have been recorded in the kingdom.

On 1 August 2013, the World Health Organization announced three new MERS-CoV cases in that Saudi Arabia, all of them in women, two of whom were healthcare workers. "With the three new cases, Saudi Arabia's posted MERS tally increases to 74 cases with 39 deaths. The cases raise the WHO's MERS count to 94 cases and 46 deaths."

On 31 October 2013, the WHO announced that three paitents in Saudi Arabia died of MERS. The patients were one woman and two men and "all had underlying medical conditions but all reported having had no contact with animals before falling ill".

Hajj

Due to fears of the MERS virus, attendance in the hajj is lower than last year. the Saudi government asked "elderly and chronically ill Muslims to avoid the hajj this year" and have restricted the number of people allowed “to perform the pilgrimage”. Saudi Health Minister Abdullah Al-Rabia said "that authorities had so far detected no cases among the pilgrims" of MERS. However, the Spanish government, in November 2013, reported a woman in Spain, who had recently travelled to Saudi Arabia, for the Islamic pilgrimage, Hajj, contracted the disease and investigators from the World Health Organization are investigating.

United Kingdom

In February 2013, the first UK case of the novel coronavirus was confirmed in Manchester in an elderly man who had recently visited the Middle East and Pakistan; it was the 10th case globally. The man's son, whom he visited in the hospital in Birmingham, was immuno-suppressed because of a brain tumour, and contracted the virus, providing the first clear evidence for person-to-person transmission. He died on 19 February 2013.

The second patient was a 49 year old Qatari man who had visited Saudi Arabia before falling ill and being flown privately by air ambulance from Doha to London on 11 September where he was admitted to St Mary's Hospital and later being transferred to St Thomas's Hospital. As a result of Dr Zaki's post on Pro-MED the novel coronavirus was quickly identified. He was treated for respiratory disease and, like the first patient in Saudi Arabia, died of renal failure in October 2012. In early October 2012, the Qatari patient residing in the United Kingdom died as well.

A further patient who had been in Guys and St Thomas hospital in the UK since September 2012 after visiting the Middle East died on 28 June 2013. "Guys and St Thomas can confirm that the patient with severe respiratory illness due to novel coronavirus (MERS-COV) sadly died on Friday 28 June, after his condition deteriorated despite every effort and full supportive treatment" Spokesman of Guys and St Thomas.

France

On 7 May 2013, one case was confirmed in Nord departement of France, the man had previously travelled to Dubai, United Arab Emirates. On 12 May 2013, a case of contamination from human to human, a man previously hospitalized in the same room as the first patient, was confirmed by French Ministry of Social Affairs and Health.

France reported its first death from the MERS near the end of May. On 28 May 2013, a report by the Associated Press said a French patient died of the novel coronavirus related to SARS. Fifty percent of those infected have died.

Tunisia

On 20 May 2013, the novel coronavirus reached Tunisia killing one man and infecting two of his relatives. Tunisia is the eighth country to be affected by MERS-CoV, along with Jordan, Saudi Arabia, Qatar, the United Kingdom, France, Germany, and the United Arab Emirates.

Italy

On 31 May 2013, the Italian health ministry announced its first case of MERS-CoV in a 45 year-old man who had traveled to Jordan. The patient is being currently treated in a hospital in Tuscany and his condition was reported as not life threatening.

Spain

On 1 November 2013, a women who had recently travelled to Saudi Arabia, for the Islamic pilgrimage, Hajj, contracted the disease. She is stated to be in stable condition and investigators from the World Health Organization, are investigating who she came in contact with.