First Case of MERS-CoV in United States

May 2, 2014 | Anna Tomasulo | Outbreak News

The Middle East Respiratory Syndrome Coronavirus, otherwise known as MERS-CoV, has arrived in the United States. Indiana reported the country’s first case on May 2.

The case, according to AP, may have been a health care worker in Saudi Arabia. The U.S. Centers for Disease Control and Prevention press release indicates that officials are still unsure about how the patient was infected. However, the CDC does know that the patient left Saudi Arabia for Indiana on April 24 and fell ill on April 27. The patient was tested for MERS-CoV because of travel history. The AP suggests that the patient is a male.

It’s been about nineteen months since the WHO first alerted the international community to MERS-CoV. The first two cases of MERS were retroactively identified in men who had fallen ill in Jordan in April 2012, which makes the outbreak at least two years old. Fittingly enough, for those who believe in the terrible twos, the outbreak has certainly become more action-packed as of late.

Prior to the announcement of the United States’ first case, three cases were reported in countries that, before now, were MERS-free. According to an April 17 update from WHO, a 54-year-old Malaysian citizen took part in a pilgrimage to Jeddah in mid-March. He reportedly visited a camel farm and drank camel milk, significant because dromedary camels have been identified as host species for MERS-CoV. This case became ill on April 4, sought treatment on April 7, and died on April 13. Additionally, Greece also reported its first case in April. A 69-year-old male Greek citizen, who had been living in Jeddah, reported to a local hospital in early April and shortly after returned to Greece for care. He was diagnosed with MERS-CoV in Greece. Finally, the WHO reported that the Egyptian Ministry of Health notified the organization of its first case: a 27-year-old man who had been living in Riyadh, Saudi Arabia, for the past four years. The case had contact with two confirmed MERS-CoV cases.

It is clear that there has been a recent increase in cases. In January 2014, the WHO reported 178 laboratory-confirmed cases. On March 27, 2014, the WHO reported 206 laboratory-confirmed cases. One month later, the WHO case count has increased by over 50 cases. As of April 26, the WHO reports 261 laboratory-confirmed cases and 93 deaths. However, the latest report from the European Centre for Disease Prevention and Control counts 424 cases and 131 deaths. The U.S. Center for Disease Control and Prevention reports 401 cases and 93 deaths. The Saudi Arabia Ministry of Health reports 378 and 107 deaths in Saudi Arabia alone.

The ECDC published a Risk Assessment report on April 24 with five hypotheses for the uptick in cases: (1) we are getting better at finding cases; (2) there is an increase in transmission from animals to humans and subsequently, increased transmission in healthcare settings; (3) there is an increase in transmission in healthcare settings due to a “breakdown” in infection control measures; (4) the virus has evolved for more effective human-to-human transmission; (5) there is an increase in false positive lab results. The report concludes that there remain important gaps in knowledge and more details are needed to completely understand the risk posed by MERS-CoV.

There is still no vaccine and no specific treatment for this virus. The CDC recommends frequent hand-washing with soap and water, covering your mouth with a tissue when you cough or sneeze, avoiding close contact with sick people, and avoiding touching your face with unwashed hands.

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