1. MERS Coronavirus: The US Response David L. Swerdlow, MD CAPT, USPHS Incident Manager, CDC MERS Coronavirus Response Associate Director for Science National Center for Immunization and Respiratory Diseases November 6, 2013

2. MERS Coronaviruses (MERS CoV) Outline Lessons from SARS Emergence and epidemiology of MERS The US response- domestic and global

4. SARS Epidemic Occurred 2002-2003 8,098 probable cases, 774 deaths Estimated economic losses >$30B Super-spreading events helped seed global spread - E.g., traveler at Hong Kong hotel spread virus to several countries Control strategies: - Surveillance to identify cases - Isolation of ill - Quarantine of exposed - Good infection control

6. MERS Coronavirus- current situation as of October 29, 2013 First case reported from KSA in September 2012 Outbreak in Jordan April 2012 identified retrospectively 150 laboratory confirmed cases with 64 (43%) deaths* Gender: 91 Males (63%), 53 Females [6 Unknown] Median age (min, max) in years: 52 (2, 94) Most with underlying conditions 24 (16%) of 150 cases health care workers

7. MERS CoV Cases and Deaths Confirmed by WHO CountriesCases (Deaths) Saudi Arabia125 (53) Qatar7 (3) United Arab Emirates6 (2) Tunisia3 (1) United Kingdom3 (2) France2 (1) Jordan2 (2) Italy1 (0) Total 150 (64)

10. Cases or clusters associated with returning travelers United Kingdom: 2/13- 3 cases, 2 deaths- Retuning traveler from KSA and family France: 4/13- 65 yo French traveler returning from UAE and 51 yo hospital roommate Tunisia: 5/13- Returning traveler from Qatar (died) and two adult children Italy: 5/13- Returning traveler from Jordan. Ill niece and co-worker were probable cases

11. Possible Environmental (Animal) Source Bats: PCR testing – Similar virus--Ghana and Europe 1 ; South Africa 2 – Identical small DNA fragment in bat sampled near first case in KSA 3 Camels: Serology – Camels from Oman (100%) and Spain (14%) had antibodies to MERS, other animals neg 4 – Camels from Egypt (94-98%), other humans and animals in Egypt and China neg 5 No direct evidence available 1 Annan A, et al. Emerg Infect Dis 2013;19:456-59; 2 Ithete NL, et al. EID 2013;10 epub; 3 Memish Z, et al, EID Ahead of Print, 8/21/13; 4 Reusken CBEM, et al. Lancet ID 2013;18:860-6; 5 Perera RA et al. Eurosurveillance 2013;18 (36) pii 20574