Viral victory: How Saudi Arabia won the war against MERS

DUBAI: It has been six years this month since the first outbreak of Middle East respiratory syndrome (MERS) was reported in Saudi Arabia, but world health experts now say the deadly virus is no longer a serious public health threat in the Kingdom.
While new infections are still being sporadically recorded, the disease, also referred to as MERS coronavirus (MERS-CoV), has fallen to record lows in 2018, according to the World Health Organization (WHO), as experts hail stringent measures put in place in Saudi Arabia — the most severely affected country — to isolate incidences of the disease. 

Dr. Amgad Elkholy, WHO epidemiologist in the Eastern Mediterranean Regional Office, told Arab News that from the discovery of MERS in 2012 up to the end of August 2018, a total of 2,246 cases of the disease were reported, including 796 related deaths — a mortality rate of about 40 percent. Most of these cases (83 percent) were reported from Saudi Arabia. 

“The number of cases in Saudi Arabia in 2018 so far falls below the average of the past few years: 108 cases from beginning of January to end of August in 2018, compared with an average of 282 cases for the same months in the past five years,” Elkholy explained.

He said that the risk of contracting MERS, which can cause acute respiratory disease, gastrointestinal problems, kidney failure and death, is now very low.

“WHO monitors the epidemiological situation of MERS-CoV, works with the affected member states to follow up on contacts, and conducts risk assessments. 

“Currently, the overall public health risk from MERS-CoV is low, and this is unlikely to change, despite the expectation that some new cases will continue to occur in Saudi Arabia and, sporadically, other countries in the region.”

Dr. Ulrich Wernery, scientific director of Dubai’s Central Veterinary Research Laboratory, which plays an important role in efforts to combat the virus, said public awareness programs and stringent precautions in health-care settings, which is how most of the known human-to-human transmissions occurred, meant that the disease is no longer “a serious threat to public safety.”

The height of the MERS-CoV epidemic was in April 2015 when 395 cases were recorded, most in Saudi Arabia (342 cases). 

However, Wernery cautioned that MERS has “not disappeared.” While he said there is no longer any concern about the virus in the Kingdom, “MERS will exist for years to come.

“If you look back to 2015 during the height of the outbreak, there was panic,” he said. “There were new cases every day, every week and there was a 40 percent fatality rate — which is big.”

Now, thanks to measures put in place, cases are few and far between. “There are still a few reported every month, but not like what we once saw, nowhere near,” said Wernery. “It has died down significantly, so we shouldn’t be worried. People now know more about the disease and are careful about it. 

“Most of the cases now are an original case, not one spread by human-to-human transmission. All hospitals in Saudi Arabia are knowledgeable about the virus and know the signs and symptoms. They know not to put these people in the main waiting room, for example, but to isolate them. So we don’t see the same spread that was so prolific a few years ago.  So there is no longer cause for panic. But people should still be aware of it and take all necessary precautions.”

The WHO also said the number of hospital-acquired cases of MERS has dropped significantly owing to improved infection prevention and control practices in hospitals.

Saudi Arabia’s Ministry of Health this year released its fifth annual report on MERS as a guideline for health-care professionals. Each year, a large group of national and international experts in epidemiology, infectious diseases, veterinary medicine and public health are hosted by the Saudi Ministry of Health to review current knowledge and update the guidelines. 

The latest report lists strict measures for health-care workers to follow if they treat a patient with potential signs of the virus, and consequent reporting of any confirmed cases.

According to WHO, the 50–59 age group continues to be at most  risk of acquiring infection of primary (or original) cases. The 30–39 age group is most at risk for secondary cases (human-to-human transmission). The number of deaths is higher in the age group 50–59 years for primary cases and 70–79 years for secondary cases.

MERS continues to exist because of the source of the disease, explained Wernery. Although some cases of MERS have been attributed to human-to-human infections in health-care settings, scientific evidence indicates that dromedaries, or one-humped camels of the kind familiar in the Gulf, are a major reservoir host for the virus and an animal source of the infection in humans. 

Wernery believes that camels that are the main source of MERS. “But we are in the Middle East, where camels are prevalent, so you can’t just eliminate the source. We have to live with it. It will be around for years to come, but there are two possibilities: Find a vaccine for the camels and/or find a vaccine for humans.”

Wernery’s laboratory is working to find a vaccine for camels.  International researchers are also working to find vaccines for humans, with candidates now awaiting clinical trials. 

However, WHO and other health groups remain optimistic. “Since 2015, the increase in the number of asymptomatic contacts identified in health-care settings is due to a policy change by the Saudi Ministry of Health, in which all high-risk contacts are tested for MERS-CoV regardless of the development of symptoms,” it said.

“I think we can expect to see further positive news about the reduced prevalence of this virus, and we hope that one day we can see zero reported cases in humans,” Wernery said.