Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Oman: Current Situation and Going Forward

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic viral respiratory illness caused by a novel betacoronavirus, which was first reported in Saudi Arabia in 2012.1 Since, MERS-CoV cases have been reported across the Arabian Peninsula, with occasional cases exported among travelers to other continents.2 Dromedary camels are a major reservoir host, in which the virus causes negligible disease.3 The virus can spread from dromedary camels to humans, through direct or indirect contact, causing significant morbidity and mortality.4 The clinical spectrum ranges from asymptomatic illness to septic shock and multiorgan failure.5 As of January 2019, a total of 2298 laboratoryconfirmed human cases of MERS-CoV from 27 countries have been reported, including 811 associated deaths giving a fatality rate of 35.2%. Eighty percent of cases have been reported from countries of the World Health Organization Eastern Mediterranean Region.2 Human-to-human transmission of MERS-CoV has been described in several closed clusters of cases, including a small family cluster of mild disease.5 Two major healthcare-associated outbreaks due to superspreading events led to massive numbers of cases and excessive morbidity and mortality in several countries.2,6 Currently, there has been no evidence of sustained human-to-human transmission.2,6 In Oman, the first laboratory-confirmed case of MERS-CoV was reported in June 2013.7,8 Up to March 2018, a total of 11 laboratory-confirmed cases have been reported sporadically.5 Ten (91%) cases were males with a mean age of 52±17.7 years (range: 20–75 years). Nine cases (82%) were primary and two cases (18%) were secondary. Patients were predominately from the North Al Batinah governorate (average rate: 1 per 100 000 population) with a fatality rate of 9%. Eight cases (73%) reported domestic camel exposure. Uncontrolled diabetes mellitus was the most common comorbidity in eight cases (73%). No secondary cases were reported among healthcare workers. Seroprevalence studies revealed MERS-CoV exposure among all sampled domestic camels across Oman.9,10 Between 27 January and 12 February 2019, a total of 13 additional human cases of laboratoryconfirmed MERS-CoV using real-time polymerase chain reaction (RT-PCR) were reported in Oman. Eight (61%) and four (39%) cases were residents of North Al Batinah and A'South Sharqiyah governorates, respectively.11 The first cluster of five females (four from the same family), reported on 27 and 28 January 2019 were residents of North Al Batinah. Their mean age was 42±10.8 years (range: 30–59 years). Three of the five cases were probably secondary cases exposed to the index case who reported a history of direct contact with camels. None of the other cases had contact with camels. However, four cases resided on a farm where camels were kept, and the fifth case had a history of contact with one of the patient’s with MERS-CoV at the hospital. Two of the five cases died (40% fatality rate). Uncontrolled diabetes mellitus and hypertension were the most common comorbidities reported among three of the cases. Between 12 and 18 February 2019, North Al Batinah and South A'Sharqiyah governorates each reported four additional cases (n = 8). These editorial Oman Medical Journal [2019], Vol. 34, No. 3: 181-183