Scientists and global public health experts have faulted Saudi
Arabia's response for allowing the spread of the Middle East
Respiratory Syndrome (MERS) virus, which has now killed nearly 300
people inside the kingdom.
Among Riyadh's failings has been the lack of a type of research
known as a "case-control" study, which compares the histories of
people with a disease to a "control group" of people who do not have
it, to try to determine what causes it.
The kingdom's chief scientist, Tariq Madani, said the study was now
under way, having so far enrolled the first 10 "cases" - people who
had the disease and either died or recovered - alongside 40
"controls" to compare them with. Ideally, the study would look at 20
cases and 80 controls, he said.
He hoped it would at last answer questions about how the virus
passes from animals to humans, where it can cause respiratory
disease and fever, and kills more than a third of people known to
The World Health Organization (WHO) and other critics say the Saudi
failure to properly investigate the causes of the disease, including
the absence of a case-control study, contributed to the virus taking
hold there and spreading via travelers to some 20 countries around
Madani, named two months ago to head a scientific advisory board at
a new health ministry Command and Control Center (CCC) to handle
MERS, said the case-control study was a central part of a "180
degree" reversal in policy, to step up the fight against the disease
and make the response more transparent.
"(This) should have been done long ago, but unfortunately it wasn't.
So it was the top priority research project we started with," he
said in a telephone interview from Jeddah.
"It will answer many questions regarding the risk factors for
acquiring MERS - particularly in the primary cases where there is no
clear source of infection such as contact with somebody else with
Saudi Arabia sacked its previous health minister in April and his
deputy in May as negative domestic opinion and global concern grew
about the response to MERS.
Madani said the new control center at the health ministry was
coordinating the response across government departments and
laboratories, and with international partners.
"Until two months ago, I was one of the scientists who had a lot of
concerns about what was going on in the kingdom - a lack of
transparency, the lack of a case-control study, etc," he said.
"I was appointed two months ago to address all of these concerns,
and now we have changed 180 degrees. We are fully committed to
transparency, our research agenda is open to everybody to comment on
and to help with."
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To help determine how MERS spreads from animals to humans, the
case-control study is designed to exclude "secondary cases" of
people who were likely to have caught it from other human patients,
"Our target was to identify the primary cases by excluding those who
had contact with people with MERS or who visited healthcare
facilities, and even those who had contact with somebody who visited
a healthcare facility, or those who had contact with somebody who
had an unexplained respiratory illness that might have been MERS,"
The team conducting the study includes several international
scientists - including experts who helped develop the WHO's guidance
for a case-control study on MERS, which was issued to affected
countries in March.
The WHO's guidance calls for including only adults in the study, and
says data should be stored in a secure database in the country in
which it is collected and that individuals' identities should be
The 22-page guidance also includes almost four pages of questions
that study subjects or their relatives should be asked about contact
with animals: For example, whether during a visit to a farm with
livestock they fed animals, cleaned animal housing or farm
equipment, slaughtered animals, assisted with animal births, milked
camels, or kissed or hugged camels.
Madani said the case-control study was the centrepiece of a 25-study
research agenda, including analyses of interactions between humans
and animals, detailed studies of outbreaks in hospitals, and
investigation into what treatment strategies are likely to be the
"We have developed a research agenda of 25 research projects, and 16
of them are currently underway," he said, adding that some 120
scientists in are working on the MERS projects in the kingdom.
"We are trying to mobilize our resources to address and answer
questions that have not been answered until now, and also to give
support and the best care to patients with MERS."
(Reporting by Kate Kelland, Editing by Peter Graff)
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