#Spatiotemporal #Clustering of Middle East Respiratory Syndrome #Coronavirus (#MERS-CoV) Incidence in #Saudi Arabia, 2012-2019 (Int J Environ Res Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Environ Res Public Health. 2019 Jul 15;16(14). pii: E2520. doi: 10.3390/ijerph16142520.

Spatiotemporal Clustering of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Incidence in Saudi Arabia, 2012-2019.

Al-Ahmadi K1, Alahmadi S2, Al-Zahrani A3.

Author information: 1 King Abdulaziz City for Science and Technology, P.O. Box 6086, Riyadh 11442, Saudi Arabia. 2 King Abdulaziz City for Science and Technology, P.O. Box 6086, Riyadh 11442, Saudi Arabia. salahmdi@kacst.edu.sa. 3 King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia.



Middle East respiratory syndrome coronavirus (MERS-CoV) is a great public health concern globally. Although 83% of the globally confirmed cases have emerged in Saudi Arabia, the spatiotemporal clustering of MERS-CoV incidence has not been investigated. This study analysed the spatiotemporal patterns and clusters of laboratory-confirmed MERS-CoV cases reported in Saudi Arabia between June 2012 and March 2019. Temporal, seasonal, spatial and spatiotemporal cluster analyses were performed using Kulldorff’s spatial scan statistics to determine the time period and geographical areas with the highest MERS-CoV infection risk. A strongly significant temporal cluster for MERS-CoV infection risk was identified between April 5 and May 24, 2014. Most MERS-CoV infections occurred during the spring season (41.88%), with April and May showing significant seasonal clusters. Wadi Addawasir showed a high-risk spatial cluster for MERS-CoV infection. The most likely high-risk MERS-CoV annual spatiotemporal clusters were identified for a group of cities (n = 10) in Riyadh province between 2014 and 2016. A monthly spatiotemporal cluster included Jeddah, Makkah and Taif cities, with the most likely high-risk MERS-CoV infection cluster occurring between April and May 2014. Significant spatiotemporal clusters of MERS-CoV incidence were identified in Saudi Arabia. The findings are relevant to control the spread of the disease. This study provides preliminary risk assessments for the further investigation of the environmental risk factors associated with MERS-CoV clusters.

KEYWORDS: GIS; Middle East respiratory syndrome; Saudi Arabia; coronavirus; epidemiology; outbreak; spatiotemporal cluster

PMID: 31311073 DOI: 10.3390/ijerph16142520

Keywords: MERS-CoV; Saudi Arabia.



#MERS #Coronavirus in #Dromedaries in #Ethiopia Is Antigenically #Different From the Middle East Isolate EMC (Front Microbiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Front Microbiol. 2019 Jun 19;10:1326. doi: 10.3389/fmicb.2019.01326. eCollection 2019.

Middle East Respiratory Syndrome Coronavirus in Dromedaries in Ethiopia Is Antigenically Different From the Middle East Isolate EMC.

Shirato K1, Melaku SK2, Kawachi K3, Nao N1, Iwata-Yoshikawa N4, Kawase M1, Kamitani W3, Matsuyama S1, Tessema TS5, Sentsui H6.

Author information: 1 Department of Virology III, National Institute of Infectious Diseases, Musashimurayama, Japan. 2 Department of Biotechnology, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia. 3 Laboratory of Clinical Research on Infectious Diseases, Department of Pathogen Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Japan. 4 Department of Pathology, National Institute of Infectious Diseases, Musashimurayama, Japan. 5 Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia. 6 Laboratory of Veterinary Epizootiology, Department of Veterinary Medicine, Nihon University, Fujisawa, Japan.



Middle East respiratory syndrome (MERS) is an emerging respiratory disease caused by the MERS coronavirus (MERS-CoV). MERS has been endemic to Saudi Arabia since 2012. The reservoir of MERS-CoV is the dromedary camel, suggesting that MERS is primarily a zoonotic disease. MERS-CoV is common in dromedaries throughout the Middle East, North Africa, and East Africa as evidenced by neutralizing antibodies against MERS-CoV; however, human cases have remained limited to the Middle East. To better understand the cause of this difference, the virological properties of African camel MERS-CoV were analyzed based on the spike (S) protein in Ethiopia. Nasal swabs were collected from 258 young dromedaries (≤ 2 years old) in the Afar region of Ethiopia, of which 39 were positive for MERS-CoV, as confirmed by genetic tests. All positive tests were exclusive to the Amibara woreda region. Using next-generation sequencing, two full-length genomes of Amibara isolates were successfully decoded; both isolates belonged to the C2 clade based on phylogenetic analysis of full-length and S protein sequences. Recombinant EMC isolates of MERS-CoV, in which the S protein is replaced with those of Amibara isolates, were then generated to test the roles of these proteins in viral properties. Amibara S recombinants replicated more slowly in cultured cells than in EMC S recombinants. In neutralizing assays, Amibara S recombinants were neutralized by lower concentrations of sera from both Ethiopian dromedaries and EMC isolate (wild-type)-immunized mouse sera, relative to the EMC S recombinants, indicating that viruses coated in the Amibara S protein were easier to neutralize than the EMC S protein. Neutralization experiments performed using S1/S2 chimeric recombinants of the EMC and Amibara S proteins showed that the neutralization profile was dependent on the S1 region of the S protein. These results suggest that the slower viral replication and the ease of neutralization seen in the Ethiopian MERS-CoV are due to strain-specific differences in the S protein and may account for the absence of human MERS-CoV cases in Ethiopia.

KEYWORDS: Ethiopia; Middle East respiratory syndrome; Middle East respiratory syndrome coronavirus; antigenicity; dromedary; neutralization

PMID: 31275264 PMCID: PMC6593072 DOI: 10.3389/fmicb.2019.01326

Keywords: MERS-CoV; Serology; Camels; Ethiopia.


#Overview of Current #Therapeutics and Novel #Candidates Against #Influenza, #RSV, and #MERS #Coronavirus #Infections (Front Microbiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Front Microbiol. 2019 Jun 19;10:1327. doi: 10.3389/fmicb.2019.01327. eCollection 2019.

Overview of Current Therapeutics and Novel Candidates Against Influenza, Respiratory Syncytial Virus, and Middle East Respiratory Syndrome Coronavirus Infections.

Behzadi MA1, Leyva-Grado VH1.

Author information: 1 Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.



Emergence and re-emergence of respiratory virus infections represent a significant threat to global public health, as they occur seasonally and less frequently (such as in the case of influenza virus) as pandemic infections. Some of these viruses have been in the human population for centuries and others had recently emerged as a public health problem. Influenza viruses have been affecting the human population for a long time now; however, their ability to rapidly evolve through antigenic drift and antigenic shift causes the emergence of new strains. A recent example of these events is the avian-origin H7N9 influenza virus outbreak currently undergoing in China. Human H7N9 influenza viruses are resistant to amantadines and some strains are also resistant to neuraminidase inhibitors greatly limiting the options for treatment. Respiratory syncytial virus (RSV) may cause a lower respiratory tract infection characterized by bronchiolitis and pneumonia mainly in children and the elderly. Infection with RSV can cause severe disease and even death, imposing a severe burden for pediatric and geriatric health systems worldwide. Treatment for RSV is mainly supportive since the only approved therapy, a monoclonal antibody, is recommended for prophylactic use in high-risk patients. The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly emerging respiratory virus. The virus was first recognized in 2012 and it is associated with a lower respiratory tract disease that is more severe in patients with comorbidities. No licensed vaccines or antivirals have been yet approved for the treatment of MERS-CoV in humans. It is clear that the discovery and development of novel antivirals that can be used alone or in combination with existing therapies to treat these important respiratory viral infections are critical. In this review, we will describe some of the novel therapeutics currently under development for the treatment of these infections.

KEYWORDS: MERS-coronavirus; antiviral; influenza; novel therapeutic agents; respiratory syncytial virus

PMID: 31275265 PMCID: PMC6594388 DOI: 10.3389/fmicb.2019.01327

Keywords: Antivirals; MERS-CoV; Avian Influenza; H7N9; RSV.


Confronting the persisting #threat of the #MERS to #global #health #security (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Confronting the persisting threat of the Middle East respiratory syndrome to global health security

Stanley Perlman, Esam I Azhar, Ziad A Memish, David S Hui, Alimuddin Zumla

Published: July 03, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30347-0


The Middle East respiratory syndrome coronavirus (MERS-CoV) is a priority zoonotic pathogen of humans highlighted in the WHO research and development blueprint list requiring urgent action 1 because it has epidemic potential, a high fatality rate with no specific treatment or vaccine, and a wide geographical distribution of the host reservoir of dromedary camels in the Middle East, Africa, and Asia. 2


Keywords: MERS-CoV: Global Health.


#Worldwide #Reduction in #MERS Cases and #Deaths since 2016 (Emerg Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Emerg Infect Dis. 2019 Sep 17;25(9). doi: 10.3201/eid2509.190143. [Epub ahead of print]

Worldwide Reduction in MERS Cases and Deaths since 2016.

Donnelly CA, Malik MR, Elkholy A, Cauchemez S, Van Kerkhove MD.



Since 2012, Middle East respiratory syndrome (MERS) coronavirus has infected 2,442 persons worldwide. Case-based data analysis suggests that since 2016, as many as 1,465 cases and 293-520 deaths might have been averted. Efforts to reduce the global MERS threat are working, but countries must maintain vigilance to prevent further infections.

PMID: 31264567 DOI: 10.3201/eid2509.190143

Keywords: MERS-CoV.


A Systematic #Review of #therapeutic agents for the #treatment of the Middle East Respiratory Syndrome #Coronavirus (#MERS-CoV) (Travel Med Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Travel Med Infect Dis. 2019 Jun 25. pii: S1477-8939(19)30109-7. doi: 10.1016/j.tmaid.2019.06.012. [Epub ahead of print]

A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Momattin H1, Al-Ali AY2, Al-Tawfiq Tawfiq JA3.

Author information: 1 Department of Pharmacy Services, King Khalid Hospital, Najran, Saudi Arabia. 2 Department of Pharmacy Services, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia. 3 Infectious Disease Unit, Specialty Internal Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaffar.tawfiq@jhah.com.




The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first described in 2012 and attracted a great international attention due to multiple healthcare associated outbreaks. The disease carries a high case fatality rate of 34.5%, and there is no internationally or nationally recommended therapy.


We searched MEDLINE, Science direct, Embase and Scopus databases for relevant papers published till March 2019 describing in vitro, in vivo or human therapy of MERS.


Initial search identified 62 articles: 52 articles were from Medline, 6 from Embase, and 4 from science direct. Based on the inclusions and exclusions criteria, 30 articles were included in the final review and comprised: 22 in vitro studies, 8 studies utilizing animal models, 13 studies in humans, and one study included both in vitro and animal model. There are few promising therapeutic agents in the horizon. The combination of lopinavir/ritonavir and interferon-beta- 1b showed excellent results in common marmosets and currently is in a randomized control trial. Ribavirin and interferon were the most widely used combination and experience comes from a number of observational studies. Although, the data are heterogenous, this combination might be of potential benefit and deserve further investigation. There were no randomized clinical trials to recommend specific therapy for the treatment of MERS-CoV infection. Only one such study is planned for randomization and is pending completion. The study is based on a combination of lopinavir/ritonavir and interferon-beta- 1b. A fully human polyclonal IgG antibody (SAB-301) was safe and well tolerated in healthy individuals and this agent may deserve further testing for efficacy.


Despite multiple studies in humans there is no consensus on the optimal therapy for MERS-CoV. Randomized clinical trials are needed and potential therapies should be evaluated only in such clinical trials. In order to further enhance the therapeutic aroma for MERS-CoV infection, repurposing old drugs against MERS-CoV is an interesting strategy and deserves further consideration and use in clinical settings.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: MERS; Middle east respiratory syndrome coronavirus; Therapy

PMID: 31252170 DOI: 10.1016/j.tmaid.2019.06.012

Keywords: MERS-CoV; Antivirals; Interferons; Ritonavir; Lopinavir; Ribavirin.


#Detection of Multiple Viral #Sequences in the #Respiratory Tract Samples of Suspected #MERS-CoV Patients in #Jakarta, #Indonesia 2015-2016 (Int J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Infect Dis. 2019 Jun 22. pii: S1201-9712(19)30267-X. doi: 10.1016/j.ijid.2019.06.022. [Epub ahead of print]

Detection of Multiple Viral Sequences in the Respiratory Tract Samples of Suspected MERS-CoV Patients in Jakarta, Indonesia 2015-2016.

Setianingsih TY1, Wiyatno A2, Hartono TS1, Hindawati E1, Rosamarlina1, Dewantari AK2, Myint KS2, Lisdawati V1, Safari D3.

Author information: 1 Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia. 2 Eijkman Institute of Molecular Biology, Jakarta, Indonesia. 3 Eijkman Institute of Molecular Biology, Jakarta, Indonesia. Electronic address: safari@eijkman.go.id.




Identification and analysis of viral etiological agents from suspected MERS-CoV cases admitted to Prof. Dr. Sulianti Saroso Infectious Disease Hospital (IDH) using molecular assays.


Biological samples were collected from 13 hospitalized patients suspected for MERS-CoV infection in Prof. Dr. Sulianti Saroso IDH from July 2015 to December 2016. Majority of patients presented with pneumonia, with symptoms including fever (≥ 37.5 °C) labored breathing and cough and travel history to the Middle East. Viral ribo-nucleic acid was isolated and converted to cDNA which was used as template for detection of 12 viral panels using conventional PCR and sequencing.


Viral etiological agents detected from the patients were enterovirus D68, dengue virus 3, rhinovirus C, human coronavirus 229E, herpes simplex 1, influenza H1N1, influenza H3N2, human metapneumovirus and rhinovirus A60.


We detected sequences of nine viral agents under different taxa including influenza, paramyxovirus, coronavirus, enterovirus, human metapneumovirus and herpesvirus in suspected MERS-CoV patients.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Indonesia; MERS-CoV; PCR; pneumonia; viral

PMID: 31238156 DOI: 10.1016/j.ijid.2019.06.022

Keywords: MERS-CoV; Indonesia.