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Upsurge in deadly virus has world on edge

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Australian health authorities are closely monitoring a recent upsurge in infections of a deadly respiratory tract virus that has so far killed more than 200 people in the Middle East.

While no cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have so far been recorded in Australia, a working group of the Communicable Diseases Network is developing advice in the event that an infection within the country is confirmed.

The disease so far has been largely confined to Saudi Arabia, where more than 85 per cent of the 701 confirmed instances of infection have occurred, though Saudi authorities are understood to be developing revised estimates that could increase the number of cases by 20 per cent and the number of fatalities by almost 50 per cent.

All cases involve people who live in, or have travelled to the Middle East, or who have had contact with those returning from these areas.

In a worrying development, surveillance indicates there was a significant upsurge in cases in April and May, mostly as a result of transmission between patients, staff and visitors at hospitals and health clinics.

The World Health Organisation has warned MERS-CoV has a 30 per cent fatality rate, and is worried about the risk of a major deadly outbreak during the Hajj pilgrimage in October when millions of Muslims are expected to make the journey to holy sites in Saudi Arabia.

Reflecting this heightened concern, the Morocco Health Minister Lahoucine Louardi has advised pilgrims to cancel plans to travel to Saudi Arabia this year because of the risk of infection.

Camels are thought to be the primary source of the virus, but WHO estimates that most cases (up to 75 per cent) involve secondary infections, the majority health workers.

Aside from Saudi Arabia, MERS-CoV infections have also been reported in the United States, Iran, the Netherlands, Greece, Turkey, Malaysia, Egypt, Lebanon, Oman, Yemen and the Philippines, Jordan, Qatar and the United Arab Emirates.

A major concern for health authorities is that much about the infection so far remains unknown, including how it may be transmitted.

“While there is no evidence indicating transmission of MERS-CoV from asymptomatic infected individuals, and no evidence of ongoing community transmission, little detail is available on a large number of the most recently reported cases, so this cannot be ruled out,” the WHO warned.

The WHO’s International Health Regulations Emergency Committee on MERS-CoV, chaired by Australia’s Chief Medical Officer Professor Chris Baggoley, has so far stopped short of the declaring the outbreak an international public health emergency.

But the Committee has expressed concern about systemic weakness in infection control in Saudi Arabia and the United Arab Emirates, and the potential for a major upsurge in cases, “especially given the anticipated increase in travel to Saudi Arabia related to Umra, Ramadan and the Hajj.”

Adrian Rollins