Middle Eastern Respiratory Syndrome

The May arrival of two cases of Middle East Respiratory Syndrome (MERS) in the US offered CDC’s BioSense SyS Program an opportunity to give CDC’s Emergency Operations Center (EOC) and state-and-local jurisdictions an enhanced national picture of MERS surveillance. BioSense jurisdictions can directly query raw data stored in what is known as “the locker.” However, CDC cannot access these data and critical functions, like creating ad-hoc syndrome definitions within the application are currently not possible. These were obstacles to providing the EOC with MERS information. BioSense staff developed a plan to 1) rapidly generate query definitions regardless of the locally preferred SyS tool and, 2) generate aggregate reports to support the national MERS response.

Objective

Demonstrate that information from disparate syndromic surveillance (SyS) systems can be acquired and combined to contribute to national-level situational awareness of emergent threats.

Centers for Disease Control and Prevention’s (CDC) BioSense system receives near real-time health care utilization data from number of sources, including DoD and VA outpatient facilities, and nonfederal hospital EDs in the US to support all-hazards surveillance and situational awareness. However, the BioSense system lacks some critical functions such as creating ad hoc definition of syndrome or ad hoc query tool development. This limits CDC Emergency Operations Center’s (EOC) ability to monitor new health events such as MERS - a viral respiratory illness first reported in Saudi Arabia in 2012. In May 2014, CDC confirmed two unlinked imported cases of MERS in the US - one in Indiana, the other in Florida. Upon report of a MERS case in Indiana, staff initiated joint efforts with EOC and several affected jurisdictions to enhance the surveillance of MERS irrespective of jurisdictions’ preferred surveillance system.

Objective

To identify and monitor Middle East Respiratory Syndrome (MERS) like syndromes cases in the syndromic surveillance system.

Public health practitioners endeavor to expand and refine their syndromic and other advanced surveillance systems that are designed to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems had been supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of H3N2v and other novel influenza A viruses required agencies to carefully identify which systems provide the most cost-effective data to support their public health practice. Recent Enterovirus D68 outbreaks, along with the global emergence of influenza A (H7N9), the global emergence of influenza A (H7N9), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Ebola virus strains, and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging disease.

Objective

To identify and characterize challenges experienced by public health practitioners conducting surveillance for the presence of influenza, novel respiratory diseases, and globally emerging viruses in an era of limited resources.

MERS-CoV was discovered in 2012 in the Middle East and human cases around the world have been carefully reported by the WHO. MERS-CoV virus is a novel betacoronavirus closely related to a virus (NeoCov) hosted by a bat, Neoromicia capensis. MERS-CoV infects humans and camels. In 2015, MERS-CoV spread from the Middle East to South Korea which sustained an outbreak. Thus, it is clear that the virus can spread among humans in areas in which camels are not husbanded.

Objective

Here we use novel methods of phylogenetic transmission graph analysis to reconstruct the geographic spread of MERS-CoV. We compare these results to those derived from text mining and visualization of the World Health Organization’s (WHO) Disease Outbreak News.