May 24, 2013 (CIDRAP News) – Saudi Arabian officials announced today that they plan to send animal samples to the United States as part of the hunt for the source of Middle East respiratory syndrome coronavirus (MERS-CoV), and also reported that testing of scores of human samples has revealed no new cases in the past 2 days.

Ziad Memish, MD, Saudi Arabia's deputy minister of public health, said in Geneva that samples from bats and other animals, including camels, sheep, and cats, would be sent to the United States, according to an Agence France-Presse (AFP) story today.

The virus, which has sickened 44 people and killed 22 in the past 13 months, is related to bat coronaviruses and is presumed to come from animals, but the source has remained a mystery. Most of the recent case-patients were not reported to have had contact with animals before they became ill, though some patients earlier in the outbreak had visited farms.

According to AFP, Memish told diplomats at the World Health Assembly (WHA) in Geneva that until now Saudi Arabia has not been able to send samples from any animals other than bats to the United States. Now, he said, "We've got an approval to move these samples and they will be shipped for testing."

Meanwhile, the Saudi Ministry of Health (MOH), which has faced considerable criticism for an alleged lack of openness about MERS-CoV, issued a statement that testing of human samples has revealed no new cases since 2 days ago, when a case was reported in the central province of Qassim.

"MOH has pointed out that 146 suspected samples have been laboratory analyzed during that period; where results proved negative," the statement said.

Response to hospital cluster

In related developments, Saudi officials offered information on their response to MERS-CoV in a slide presentation at the WHA yesterday. It included some details on the hospital-centered case cluster in the country's Eastern province, which began in April and includes 22 cases with 10 deaths. Media reports have identified the facility as Al-Moosa General Hospital in Hofuf.

The facility has 150 beds, including a 12-bed critical care unit, and 32 hemodialysis chairs, according to the Saudi presentation. Reports of deaths from viral pneumonia in the hospital started in mid April, and the first MERS-CoV case was identified on Apr 24. Saudi officials immediately notified the World Health Organization (WHO) and also invited consultation teams from the WHO and several universities, including the University of Toronto, Johns Hopkins in Baltimore, and the University of Denver.

No new MERS-CoV cases have been acquired at the hospital since May 1, although cases have been found since then in a few family contacts and in two healthcare workers, according to the presentation. It said more than 500 contacts were tested in the investigation of the cluster.

"Active surveillance kingdom-wide is ongoing with more than 1,000 samples tested to date," officials reported. They also said they plan to hold an international consultation on the issue soon with the WHO and experts from several disciplines.

Erasmus rejects criticism

In related news today, Erasmus Medical Center in the Netherlands, reacting to comments made at the WHA yesterday, rejected allegations that it is impeding the investigation of the MERS-CoV outbreak by imposing restrictions on the use of virus samples it provides to other labs. Erasmus scientists were the first to analyze and identify the virus last year, after a physician in Saudi Arabia sent them a specimen.

Researchers who want to secure MERS-CoV samples from Erasmus must sign a material transfer agreement (MTA) that deals with user rights and responsibilities. WHO officials and others at the meeting in Geneva said restrictions in the MTA have delayed some research, including development of serologic tests, according to press reports.

In today's statement, Erasmus said it "strongly refutes all allegations concerning a presumed lack of willingness to cooperate in research into the new MERS coronavirus." The center's Viroscience Department said it has sent the virus free of charge to many public research and health institutions that can work with it safely.

"It should be clear that a virus cannot be patented, only specific applications related to it, like vaccines and medicines," the statement said. "Rumours that the Viroscience department of Erasmus MC would hamper research into the MERS coronavirus are clearly wrong and not based on facts."

It said further that the use of an MTA is common when shipping viruses. "Such an MTA covers issues like liability and limitations to commercial use. Consequently the virus may not yet be used for commercial purposes and may not be distributed to third parties without permission. These are the usual conditions covered by [an] MTA."

"Ab Osterhaus and Ron Fouchier of Erasmus MC stress that 'every research or public health laboratory that complies with the safety criteria for handling MERS coronavirus can work with it,'" the statement continues. "It is clearly a misunderstanding that Erasmus MC owns the virus."

Erasmus is not the only source for samples of the virus. A WHO official told CIDRAP News that the agency knows of other labs that have shared samples. Also, the US Centers for Disease Control and Prevention (CDC) said it secured samples from the United Kingdom.

CDC spokeswoman Sharon Hoskins said restrictions tied to the acquisition of the UK samples bar any commercial use of them. "Also the distribution by CDC to other organizations is prohibited without permission from the originating source," she commented by e-mail. "These types of restrictions are not unique to MERS-CoV."

Hoskins said that because there are no MERS-CoV cases in the United States, the CDC does not have the option to share samples with any other countries or organizations.

However, the agency "has developed MERS-CoV molecular diagnostics and has distributed testing kits to domestic public health laboratories through the Laboratory Response Network as well as to other groups," she said.

In addition, the CDC has developed assays to detect antibodies to MERS-CoV, she said. "We intend to use these assays to test specimens collected from potential cases in past and future public health investigations. However, these assays are not yet ready to be disseminated."

See also:

May 24 AFP report on Saudi plan to send samples to CDC

May 24 Saudi MOH statement

Saudi slide presentation from WHA

May 24 Erasmus statement