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The WHO’s Emergency Committee convened concerning Middle East respiratory syndrome coronavirus (MERS-CoV), and concluded the seriousness of the situation had increased in terms of public health impact, but that the conditions for a Public Health Emergency of International Concern (PHEIC) have not yet been met.
Dr Jeremy Farrar, Director of the Wellcome Trust said:
“The decision not to declare MERS CoV a public health emergency is a very sensible decision. However, we have to ask why after more than 20 months since this virus first emerged there remain so many unanswered questions. We know very little about this infection and its underlying epidemiology, transmission ability, disease progression or the biology of the virus itself. We also don’t know for sure what the animal reservoirs are, how this virus crosses from animals to humans and how many humans have been infected. These are crucial questions in understanding its potential to spread and how to implement effective public health measures. SARS became a global problem within weeks and we are watching as this related virus slowly makes its way throughout the population in the Middle-East and beyond. There have been major gaps at every stage of reacting to this infection and as a result we have no greater understanding of it after nearly two years”.
“Today’s verdict calls for more scientific studies to be initiated and completed to gain an understanding of the infection but these have been needed since day one. Much better surveillance has allowed us to identify the emergence of these new infections, but surveillance remains only part of the solution. We do not know how best to treat patients or what interventions may work and therefore save lives. We need to develop our capacity not only to identify new infections but to then respond and intervene to such an emergence”.
Dr Jake Dunning, Centre for Respiratory Infection, National Heart and Lung Institute, Imperial College London, said:
“The WHO committee has again given very careful consideration to the risks to global health posed by MERS coronavirus (MERS-CoV). The vast majority of infections have been in the Middle East, although some people who acquired the infection in the Middle East have travelled to other countries where they were diagnosed and treated. The good news is that detailed outbreak investigations and analysis of the latest virus isolates suggest that MERS-CoV has not evolved into an infection that spreads easily between humans.
“Just because this is not a “public health emergency of international concern” does not mean that we should dismiss this virus, however. Outbreaks in hospitals are always a serious concern and the committee’s report suggests that they occured when infection control precautions were sub-optimal. Furthermore, this should not be seen as a problem that only concerns the Middle East. Global travel means that cases have occurred and will continue to occur in other regions, including Europe and North America.
“Doctors in other countries who see patients with compatible symptoms and who have recently arrived from affected countries first need to think whether MERS is possible – this is not an easy task with a relatively rare infection! Doctors then need to take appropriate steps to isolate suspected cases and perform diagnostic tests, with the aim of preventing infection in others, including hospital patients and those who care for them.
“We do not know whether the virus will change in the future and will spread more easily between humans. There are still many unknowns and we need a lot more focussed research. However, we are learning more about this novel infection all the time, including its presence in animals such as camels and bats and the roles these animals may play in transmission to humans.
“Recently we have seen a marked increase in cases in the Middle East, often severe cases but also an increasing number of milder cases. This may reflect changes in methods of screening for infections in the Middle East, as well as possible seasonal variations in infection (in camels and in humans). There may well be a reasonable number of milder MERS infections out there, which would impact on calculation of the estimated case fatality rate. We need additional, detailed studies to assess just how widespread and dangerous this infection is.
“The WHO evaluation of the situation is sensible and considered. Like many novel viruses, it is impossible to predict whether MERS-CoV will evolve to pose a greater threat to global health, as we saw with SARS coronavirus. There are plenty of people monitoring the situation, so there’s no need to panic. Right now, a major priority is the rapid identification of infected patients and prevention of further outbreaks in hospitals in the Middle East and elsewhere. Global collaboration is the best way to achieve this.”
Professor Nigel Brown, President, Society for General Microbiology, said:
“The Society for General Microbiology welcomes the WHO emergency committee’s findings and agree with its statement that basic infection controls to prevent hospital-acquired infections, such as hand-washing, and the correct use of gloves and masks in hospitals, will be important in stopping further spread of the MERS virus.
“Control measures must go hand-in-hand with increased virology and epidemiology research to understand how the MERS virus is infecting people, and the role that animal-to-human transmission plays in spreading the disease.”
Jeff Evans, Senior Lecturer in Disaster Healthcare, University of South Wales, said:
“For me the take home messages are:
· There is no global public health emergency
· Sustained person-to-person transmission has not been shown to be taking place, i.e. it is difficult to catch out and about in normal life
· The UK has good primary healthcare and public health surveillance systems when compared with vulnerable countries identified by WHO so early identification and intervention is the norm in the UK
· Whilst there has been a recent rise in identified case and fatalities, the case fatality rate has dropped from 60% to 25% ; mostly due to increased awareness leading to early identification http://www.medscape.com/viewarticle/824986#1
· Camels seem to be playing a role in transmission but the actual route of transmission is unclear so avoid contact with camels and food stuffs of camel origin (camel milk & meat)
· Observe and promote good personal hygiene and infection control if you are travelling to a MERS-CoV affected region, hand washing and ‘catch it, bin, it kill it’. Be sure to be alert to flu like symptoms during travel and upon return to UK, inform any healthcare providers of recent trips to MERS-CoV affected regions.”
Dr Ben Neuman, a virologist at the University of Reading, said:
“This is a measured and sensible reaction to an evolving epidemic. There is already a substantial worldwide effort between scientists, doctors and public health officials to understand and stop the spread of MERS coronavirus. It is important to remember that MERS still does not spread very efficiently between people. It is a very serious disease if you are unlucky enough to catch it, but the odds of catching the virus – even in Saudi Arabia – are still very small.
“To be considered a potential Public Health Emergency of International Concern (PHEIC), essentially the disease has to spread faster than any response could cope with.
“Centres for Disease Control and Prevention state that the event would have to meet two of the four following criteria: Is the public health impact of the event serious? Is the event unusual or unexpected? Is there a significant risk of international spread? Is there a significant risk of international travel or trade restrictions?
“With cases still very rare, all transmission currently being directly linked to the Middle East and no serious threat of travel or trade disruption, the current MERS outbreak probably only meets one of the four criteria at most. The recent spike in the number of cases is concerning, but the total number of cases is still small enough that a few transmission events can have a big effect on how severe the outbreak appears. This is the third Spring when the number of MERS cases has risen and the best case scenario is that this is just a temporary blip in the natural cycle of the virus.”
Prof Ian Jones, Professor of Virology, University of Reading, said:
“Although the recent spike in cases appears alarming the basic facts about MERS remain unchanged: it is an animal virus that only occasionally infects man. There is no evidence of any change in the virus that could herald wider spread. The cases in transit through the UK are health care workers who have come into contact with an unknown source of MERS. They have not passed the virus more widely and the general risk assessment remains very low. These recent hospital acquired cases don’t appear to have had any notable camel contact, so the origin of the infection remains unclear.”
http://www.who.int/mediacentre/news/statements/2014/mers-20140514/en/
Declared interests
Jake Dunning is an infectious diseases doctor and researcher, with a particular interest in novel respiratory viruses. He participates in clinical management and research activities for MERS-CoV with WHO and the International Severe Acute and emerging Infections Consortium (ISARIC).