May 28, 2013 (CIDRAP News) – Saudi Arabia reported today that five more people have been infected with the Middle East respiratory syndrome coronavirus (MERS-CoV), as if to underline yesterday's warning from the head of the World Health Organization (WHO) that the novel virus is a global threat.

In a brief statement, the Saudi Ministry of Health (MOH) said, "Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that five novel Coronavirus cases have been recorded among citizens in the Eastern Region, ranging in age from 73 to 85 years, but they have all chronic diseases."

Also, two more deaths from MERS have been reported in the past few days. Yesterday Agence France Presse (AFP) reported the death of France's first MERS-CoV patient, a 65-year-old man whose illness was first reported on May 8. And on May 26 the Saudi MOH announced the death of an 81-year-old woman.

With today's Saudi announcement, the unofficial global case count has reached 49; the death toll stands at 24, according to the US Centers for Disease Control and Prevention (CDC). Unofficially, Saudi Arabia has had 37 cases, with 18 deaths.

WHO concern

Deep concern about MERS-CoV was expressed yesterday by WHO Director-General Margaret Chan, MD, MPH, as she closed the annual World Health Assembly (WHA), the WHO's policy-making body.

"Looking at the overall global situation, my greatest concern right now is the novel coronavirus," she said as quoted in a WHO press release. "We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control.

"These are alarm bells and we must respond. The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself. The novel coronavirus is a threat to the entire world."

The WHO plans to send a second team to Saudi Arabia in coming weeks to help investigate the mysterious virus, according to a May 25 Arab News story that quoted Chan. The source of the pathogen remains unknown, but several case clusters have shown that it can spread between people in close contact.

"Without that proper risk assessment, we cannot have clarity on the incubation period, on the signs and symptoms of the disease, on the proper clinical management and then, last but not least, on travel advice," Chan told Arab News.

The WHO, which sent a group of experts to Saudi Arabia earlier this month, will provide a fresh risk assessment ahead of this year's Haj pilgrimage, which will take place in October, the story said.

Details on deaths

Concerning the five new cases, the Saudi MOH left many questions unanswered, including whether the patients are part of a hospital-centered outbreak of MERS-CoV that began in April in the Al-Ahsa region of Eastern province. The cluster has been reported to include 22 cases with 10 deaths. The statement gave no information on the patients' conditions, gender, where they live, or how long they have been sick.

The French patient who died became ill on Apr 23, six days after he returned home from a vacation in Dubai, United Arab Emirates. Another person contracted the virus after sharing a hospital room with him from Apr 27 to 29.

The 81-year-old Saudi woman who died was among the previously announced cases in Al-Ahsa governorate, the Saudi MOH said in a May 26 statement. It said she was suffering from chronic kidney failure and other chronic diseases.

Her case appears to be the one announced by the WHO on May 18. That announcement said the 81-year-old's illness was the 22nd case in the hospital-centered cluster in Al-Ahsa.

The May 26 MOH statement also said that nine other case-patients have recovered and been discharged from hospitals since the first MERS-CoV in Saudi Arabia, which occurred in June 2012.

MERS-CoV designation

In other developments, the WHO announced today that it is accepting the name MERS-CoV for the novel virus, despite a general aversion to geographic references in the names of newly discovered viruses.

"Given the experience in previous international public health events, WHO generally prefers that virus names do not refer to the region or place of the initial detection of the virus," the agency said in a statement. "This approach aims at minimizing unnecessary geographical discrimination that could be based on coincidental detection rather than on the true area of emergence of a virus."

The name was proposed by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses, the WHO noted. The statement said the term emerged from consultations with a large group of scientists and represents an acceptable consensus

Patent issues

Also today, a story in BMJ offered more details on intellectual property issues related to MERS-CoV. Albert Osterhaus, DVM, PhD, head of viriology at Erasmus Medical Center in the Netherlands, told the journal that Erasmus has applied for patents on MERS-CoV genetic sequences and on possible related products such as diagnostics and vaccines.

Erasmus scientists were the first to analyze the virus and identify it as novel last year, after an Egyptian physician working in Saudi Arabia sent them a sample. Last week Chan and Saudi officials complained that restrictions imposed by Erasmus on use of MERS-CoV samples that it has supplied to other labs were impeding the investigation of the outbreak.

Erasmus officials have rejected the criticism and said they have supplied samples to all labs that want to use it for public health research and are equipped to handle if safely. But Osterhaus told BMJ, "We have patent applications submitted and that is on the sequences and the possibilities to eventually make diagnostics, vaccines, antivirals, and the like. It's quite a normal thing if you find something new to patent it."

He added that Erasmus has not made a deal with any company yet, because it's too early. "At the end of the day, if you want something to happen for the benefit of public health—including making a vaccine, antivirals, whatever—you need to have at least some intellectual property. Otherwise the companies will not be interested," he said.

At the WHA, Chan promised that the WHO would work with Saudi Arabia to look at the "legal implications" of the issue.

See also:

May 28 Saudi MOH statement on new cases

May 26 Saudi MOH statement on death of 81-year-old

May 28 AFP story on death of patient in France

May 27 WHO press release with Chan comments on MERS CoV threat

May 25 Arab News story on WHO plan to send another team to Saudi Arabia

May 28 WHO statement on virus name

May 28 BMJ story