Highlights from the fifth IMED
Authors: Raffaella Bosurgi
Journal: The Lancet Infectious Diseases (2014)

The fifth International Meeting on Emerging Diseases and Surveillance (IMED) was held from Oct 31, to Nov 3, 2014, in Vienna, Austria. Raffaella Bosurgi reports. IMED opened with Ziad Memish's (Ministry of Health, Riyadh, Saudi Arabia) plenary lecture providing an update on the challenges, advances, and developments concerning the Middle East respiratory syndrome (MERS) outbreak. A total of 897 laboratory-confirmed cases have been reported to WHO, including 352 deaths. Memish reported on how the virus behaves differently compared with severe acute respiratory syndrome (SARS). There have been 897 cases of MERS with a 40% mortality rate, whereas SARS cases were 8000 in 6 months with a 10% mortality rate. MERS coronavirus has shown three different patterns of transmission: sporadic community cases, family clusters (where patients are in the same household), and community-derived infection. More diagnostic testing is needed—the more you test the more you find. Diagnosis relies on RT-PCR, with the greatest yield found in samples from the lower respiratory tract. Such facilities are lacking in most places, and it is for this reason that many cases are missed said Memish. Genome sequencing is very important for tracking the outbreak, but this relies on sample quality. The higher the viral load the better the chance for a yield high enough for full genome sequencing. He reported that neither bats nor camels are the only reservoirs of infection. Only a third of patients have known contact with camels; hence, they cannot be the only source of infection. Oyewale Tomori (President of the Nigerian Academy of Science, Lagos) gave a moving lecture illustrating what can be learned from the 2014 Ebola outbreak in west Africa. In 1995, the outbreak of viral haemorrhagic fever-like illness in Kikwit, Democratic Republic of the Congo, caused 254 deaths with a fatality rate of 81%. “The good fact was that when the infectious diseases control got into place within 4 weeks, hospitals were back to normal”, he told TLID. Compared with what is happening now with the current Ebola outbreak, the international response in 1995 was quicker and better coordinated because WHO intervened quickly and provided immediate support to the affected country. Therefore, the epidemic was immediately stopped and contained, he told TLID. The weak infrastructure, the great corruption of the affected countries, years of civil wars, and lack of timed international support through WHO, are the main reasons for what is happening today, Tomori said. “National governments need to regain the confidence in people because they have lost credibility in the past. The international community can help by providing support to the affected countries with the scientific community, but to do so they must guarantee they are protected and safe. This is our problem. The African saying ‘we will meet tomorrow to discuss things that happened yesterday’, needs to be replaced by better strategy and planning”, he told TLID. Simon Anthony (Columbia University, New York, NY, USA) gave a presentation on virodiversity, outlining what his group is doing to understand the number of viruses carried by a single species. They took repeated urine and throat samples (n=1700) and used PCR to detect and assess patterns of virus carriage. 55 viruses—of which 50 were novel—from seven viral families were detected in the bat Pteropus giganteus (four different coronavirus, 11 paramyxoviruses, three polyiomaviruses, 14 adenoviruses, 13 herpesviruses, two bocaviruses, and eight astroviruses). A simple extrapolation method allowed them to estimate that there are still 320 000 mammalian viruses awaiting discovery and the estimated cost of such research would be about US$6·3 billion. Adriano Duse (Johannesburg, South Africa) posed the question: who between the human being and the microbe is the real superbug? The interaction between a host and pathogen is easily controlled; what seems to be really difficult is the human component. Ebola haemorrhagic fever of Africa illustrates the interconnection between the nature of human beings, microbes, and the environment. Filovirus outbreaks are largely created by people and driven by their behaviour, he reports. In the case of Ebola virus transmission, contamination and fomites do not pose a significant risk if recommended infection preparation practices are applied; there is no risk from casual skin contact with asymptomatic people. What instead are considered to be risk factors are hunting, slaughtering, and butchering of animals, communities and hospitals with patients who have viral haemorrhagic fevers, preparation of bodies, and attending funerals. Good infection prevention and control need to be applied and monitored to ensure that local communities are protected. The International Society for Infectious Diseases, organisers of IMED, is offering travel bursaries for individuals wanting to go to US Centers for Disease Control and Prevention to take the biosafety course before travelling to west Africa http://www.isid.org/grants/grant_ebola_training_travel.shtml The International Society for Infectious Diseases, organisers of IMED, is offering travel bursaries for individuals wanting to go to US Centers for Disease Control and Prevention to take the biosafety course before travelling to west Africa http://www.isid.org/grants/grant_ebola_training_travel.shtml