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MERS is still a threat

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The World Health Organization has issued a June 11 report on the cases of MERS, Middle East Respiratory Syndrome, which were diagnosed in Iran. It also includes confirmed worldwide totals for illnesses. The WHO states that it has records for 683 cases of MERS and 204 deaths.

The two Iranian MERS cases are in middle-aged sisters. They have had no contact with camels or camel products. One of the two did have close contact with a woman who returned from a pilgrimage to Saudi Arabia with an influenza-like illness.

Saudi Arabia remains at the center of the outbreak of MERS infections. As of June 10, the Kingdom was reporting 700 total cases and 287 deaths. Not all the cases have been reported to the WHO while others are being held, the agency states, pending receipt of additional information.

On June 3, the Saudis announced that a review of records has turned up an additional 113 cases of the viral illness. There were 92 additional deaths caused by MERS Co-V in that data. The Kingdom has offered no explanation for the mysterious discovery and it has released little patient data with respect to those cases.

Emblematic of the problems that the public health sector in Saudi Arabia has had in dealing with the MERS outbreak is the current controversy over two medical papers, published in two different journals, about the same data. The two papers reported on the testing of a patient with MERS and the testing of the camels that he owned.

As discussed in the American Association for the Advancement of Science's Science Insider:

The double publication—the first in Emerging Infectious Diseases (EID), the other later in The New England Journal of Medicine (NEJM)—has pitted Saudi Arabia's former deputy minister of health, Ziad Memish, against infectious diseases specialist Tariq Madani of King Abdulaziz University in Jeddah, who recently became the Saudi government's chief scientific adviser on MERS.

The Science Insider piece also reveals that the conclusions of both papers may be incorrect. The Memish paper, published first, suggested a link between camels and the patient's illness while the Madani paper made that its conclusion. Examination of the papers and the data that has been released has suggested to some that cross contamination occurred. The human samples were somehow also tested as the camel samples.

The Saudi public health and medical professionals working on the MERS outbreak have accepted the assistance of professionals from the WHO and the Centers for Disease Control. The number of human to human infections that was happening in the hospital appears to have nearly stopped. The rate of infection among health care workers has also dropped.

A great many questions remain unanswered about MERS at this time. With personnel and policy changes in Saudi Arabia, the outbreak has slowed significantly. A threat remains, as the new cases in Iran illustrate, but it appears to be far less than it appeared in April.

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