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Mers - will it start the next global pandemic? Mers - will it start the next global pandemic?
(3 days later)
Since April 2012, 108 cases of a new virus have been reported in humans, resulting in 50 deaths. Middle East respiratory syndrome (Mers) is in the same family as Sars (severe acute respiratory syndrome) and the common cold (coronaviruses), but is more closely related to viruses found in bats. The potential emergence of a new virus for which there is no treatment or vaccine is cause for concern. Still, it is far from certain that Mers will result in a pandemic.Since April 2012, 108 cases of a new virus have been reported in humans, resulting in 50 deaths. Middle East respiratory syndrome (Mers) is in the same family as Sars (severe acute respiratory syndrome) and the common cold (coronaviruses), but is more closely related to viruses found in bats. The potential emergence of a new virus for which there is no treatment or vaccine is cause for concern. Still, it is far from certain that Mers will result in a pandemic.
The term pandemic refers to any epidemic that spreads globally, rather than being confined to a particular location. Not all pandemics result in major mortality. Influenza pandemics occurred in 1957, 1968 and 2009, but none led to a large number of deaths. However, the great influenza pandemic of 1918 may have killed as many as 100 million people, and is one reason there is so much concern whenever a potentially pandemic virus such as Mers emerges. Pandemics of new viruses have the potential to kill so many not because mortality rates are necessarily high, but because nearly the entire population is susceptible. Even the 1918 pandemic killed only one to three people out of every 100 infected, but it infected as much as 50% of the world's population.The term pandemic refers to any epidemic that spreads globally, rather than being confined to a particular location. Not all pandemics result in major mortality. Influenza pandemics occurred in 1957, 1968 and 2009, but none led to a large number of deaths. However, the great influenza pandemic of 1918 may have killed as many as 100 million people, and is one reason there is so much concern whenever a potentially pandemic virus such as Mers emerges. Pandemics of new viruses have the potential to kill so many not because mortality rates are necessarily high, but because nearly the entire population is susceptible. Even the 1918 pandemic killed only one to three people out of every 100 infected, but it infected as much as 50% of the world's population.
In 2002, Sars emerged in the human population in China. Sars is likely to have jumped to humans from palm civets sold in wet markets, and quickly spread to four continents. More than 8,000 people were infected by the summer of 2003, and 10% of those died. But Sars never spread widely in the general community, and died out without causing the severe pandemic that was feared.In 2002, Sars emerged in the human population in China. Sars is likely to have jumped to humans from palm civets sold in wet markets, and quickly spread to four continents. More than 8,000 people were infected by the summer of 2003, and 10% of those died. But Sars never spread widely in the general community, and died out without causing the severe pandemic that was feared.
As of 3 September, 108 cases of Mers had been reported in countries as diverse as Jordan, Italy and the UK. The vast majority have occurred in Saudi Arabia, and all chains of transmission have originated in the Middle East. Like Sars, Mers can be transmitted through the air and appears to spread particularly well in healthcare settings – most confirmed cases of human-to-human transmission have occurred in hospitals. The distribution of Mers cases suggests that incidence has been sustained by animal-to-human transmission. Mers is closely related to bat viruses, but no link to bat exposure has been proved. While other candidates have been suggested (camels, for instance), the animal source of Mers remains unknown.As of 3 September, 108 cases of Mers had been reported in countries as diverse as Jordan, Italy and the UK. The vast majority have occurred in Saudi Arabia, and all chains of transmission have originated in the Middle East. Like Sars, Mers can be transmitted through the air and appears to spread particularly well in healthcare settings – most confirmed cases of human-to-human transmission have occurred in hospitals. The distribution of Mers cases suggests that incidence has been sustained by animal-to-human transmission. Mers is closely related to bat viruses, but no link to bat exposure has been proved. While other candidates have been suggested (camels, for instance), the animal source of Mers remains unknown.
Because the virus has successfully passed between humans, there is reason to be concerned that it may grow into a pandemic. However, human-to-human transmission is not enough. For a pandemic to occur, each person infected needs to, on average, infect one or more others. So far, this does not appear to be happening. Transmission is the result of biology, social interaction and the environment. Mers may evolve the ability to spread in humans, or already have this ability under some social or climatic conditions. A particular concern is the millions who will converge on Saudi Arabia in mid-October for the hajj.Because the virus has successfully passed between humans, there is reason to be concerned that it may grow into a pandemic. However, human-to-human transmission is not enough. For a pandemic to occur, each person infected needs to, on average, infect one or more others. So far, this does not appear to be happening. Transmission is the result of biology, social interaction and the environment. Mers may evolve the ability to spread in humans, or already have this ability under some social or climatic conditions. A particular concern is the millions who will converge on Saudi Arabia in mid-October for the hajj.
So Mers poses dangers, but there is reason for caution, not panic. Much was learned about how to control respiratory viruses in hospitals during the Sars pandemic, and these lessons may help to keep Mers contained.So Mers poses dangers, but there is reason for caution, not panic. Much was learned about how to control respiratory viruses in hospitals during the Sars pandemic, and these lessons may help to keep Mers contained.
But even if Mers does not become pandemic, mammalian coronaviruses clearly warrant close scrutiny. If we are witnessing a potential pandemic, we have limited opportunities to prevent it. In either case, open communication is essential in the scientific and public health response to the emergence of Mers.But even if Mers does not become pandemic, mammalian coronaviruses clearly warrant close scrutiny. If we are witnessing a potential pandemic, we have limited opportunities to prevent it. In either case, open communication is essential in the scientific and public health response to the emergence of Mers.
Dr Justin Lessler is an assistant professor of Epidemiology at the Johns Hopkins Bloomberg School of Public HealthDr Justin Lessler is an assistant professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Health
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