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MERS epidemic “unlikely” in Egypt

Published online 2 June 2014

Egypt's recent record of uncontrolled epidemics has brought fears of a widespread outbreak of the MERS-CoV virus, but experts say the virus in its current form is unlikely to become an epidemic in the country. 

Louise Sarant

Several airports have started to screen arriving passengers for MERS.
Several airports have started to screen arriving passengers for MERS.
© epa european pressphoto agency b.v. / Alamy
A man admitted to the Abbasseya hospital this month, shortly after arriving in Cairo from Saudi Arabia, is so far the only confirmed case of the Middle Eastern respiratory syndrome coronavirus (MERS-CoV) in Egypt. 

Sources at the Ministry of Health say he is now fully recovered and is expected be discharged from hospital soon. 

Sahar Mahmoud Samy, an epidemiologist in the Surveillance Unit at the Ministry of Health, also pointed to an earlier case of a woman, locally reported to have been infected, The 60-year-old died before the necessary tests could be performed that would reliably confirm she had contracted the coronavirus.

Around 140 patients who exhibit MERS symptoms and have travelled to the Gulf region, currently the epicenter of the virus, remain under observation in hospitals across Egypt. 

MERS-CoV has shown relatively low transmission efficiency between humans, says Islam Hussein, a research scientist at MIT Division of Comparative Medicine, Center of Excellence for Influenza Research and Surveillance. This reduces the likelihood of it becoming an H1N1 type epidemic.

“If the virus ever acquires mutations that would enable it to transmit more efficiently between humans, then it will become a global health problem,” Hussein says. In the past, Egypt has failed to curb similar virus outbreaks, especially given inadequate infection control measures inside its hospitals. 

Because of MERS-CoV's limited human-to-human transmission, the WHO’s Emergency Committee has not declared the virus a Public Health Emergency of International Concern (PHEIC) – which would see travel restrictions to the most affected countries, such as Saudi Arabia and the UAE, and increased pressure on their governments 

The latest figures indicate 636 confirmed coronavirus cases worldwide, most of them in Saudi Arabia. Major outbreaks in hospitals in Jeddah and Riyadh saw the total number of cases nearly double in April, and rise by a further 25% in May.

As the Ummrah and Hajj pilgrimage seasons draw near, during which millions of pilgrims converge in the city of Mecca in Saudi Arabia, the risk looms of a spread of infections to Egypt and elsewhere. 

“We are taking every measure to prevent such a scenario,” says Aida Metwally, a professor of community medicine and head of the infection control unit at the National Research Center (NRC) in Egypt. Metwally says there will be detection equipment at airports, infection control inside hospitals and awareness campaigns for health practitioners and the general public.

However, Hussein says that SARS and the 2009 H1N1 pandemics suggest that airport screening is ineffective. “Infected people can cross the thermal detector checkpoint easily without being detected if they are still in the incubation period and show no symptoms,” he explains. MERS patients can take up to two weeks to develop symptoms.

WHO does not recommend the use of fever thermometers at airports either, since they create a “false sense of security.”

“Infection control inside hospitals is crucial,” says Hussein. Most infections could be prevented if health practitioners washed their hands regularly, wore masks and gloves.

Control of the spread will depend on whether Egypt has the ecological factors necessary to maintain the cycle of disease transmission, explains Hussein. “Although not clear yet, it seems that camels are playing a role [in transmission], and camels are not as significant in Egypt as in Saudi Arabia, so these are all encouraging signals that MERS in Egypt may not be as big of a problem,” he adds.

According to Keiji Fukuda, assistant director general for health security at WHO, if MERS is associated with a particular animal and research confirms that the virus is mostly transmitted from animal to human, then it will remain regional. “But if transmission between people increases, the virus could present a global risk,” he says.