MERS: Some ask where are the paediatric cases ?

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   Hi

Not my original observation but someone elses, so I don't take credit for this one.

So I was reading comments linked to an infectious disease journal. One comment ( from someone  who was a data analyst for initial outbreaks of novel infectious diseases), well he  highlights a good point, that MERS seems to  be differentially infecting adults compared to children or adolescents. Why this is the case is not clear. ( anyone here any suggestions). 

As I shouldn't post links to another site I will summarise what the writer said but put it in my OWN words.  I will also post link below to the ECDC data the writer talked about so anyone can check out the statistics for themselves ( I did).

  So basically this comment  was saying that historically there has been very few paediatric cases of MERS reported among the cases in Saudi Arabia ( according to WHO statistics children make up only about 3% of the MERS cases).

2 main ideas were touted.  
1)  Saudi Arabia were missing or even covering up child infections. 

2)  It was zoonotic and it tended to be adults that worked closer with the grumpy unpredictable but very valuable camels.  Children were normally put to work with sheep, small cattle etc.

 However the comment writer then describes ongoing events in South Korea 700 miles from Saudi, and low and behold again very few children are reported being ill with MERS. ( WHO states only one child hospitalised.) 

So by comparing 2 data sets from 2 different countries similarities are beginning to emerge. ECDC have some good graphs on the data ( link below). So confirmation that pediatric cases are rare in South Korea, and seem also rare in Saudi Arabia. 

So 

1) Saudi were probably not missing or covering up child cases of MERS. 

2) As all of the MERS cases in  South Korea are a result of human to human transmission and not the virus  jumping from an animal host to humans, lack of exposure to infected camels may not be what is giving low paediatric numbers.

Anyway I found the comments quite interesting, though the author didn't make any suggestions as to why cases of MERS in children are disproportionately low. I also thought it was a bit of a leap for the author to conclude  that MERS was differentially infecting adults compared to children ( as we dont know if children are being infected and just reacting differently).  

So I thought I would ask you lot to take the observation further.

Do you think the  children are getting infected but being asymptomatic ? 

Is there any other infectious disease that causes severe illness in adults, but mild self limiting disease in children ? (Chicken pox, or mumps I guess they are totally different in severity in adults and children).

 Anyone any idea where the paediatric cases of MERS are ?

Hzx

Link showing age distribution of MERS cases.

http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1244&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2Fhealthtopics%2Fcoronavirus-infections%2FPages%2Fnews_and_epidemiological_updates%2Easpx

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Hazelpad Members Profile Send Private Message Find Members Posts Add to Buddy List Adviser Group Joined: September 09 2014 Status: Offline Points: 6910	Post Options Post Reply Quote Hazelpad Report Post Thanks(0) Quote Reply Topic: MERS: Some ask where are the paediatric cases ? Posted: July 07 2015 at 6:22pm
	Hi Not my original observation but someone elses, so I don't take credit for this one. So I was reading comments linked to an infectious disease journal. One comment ( from someone who was a data analyst for initial outbreaks of novel infectious diseases), well he highlights a good point, that MERS seems to be differentially infecting adults compared to children or adolescents. Why this is the case is not clear. ( anyone here any suggestions). As I shouldn't post links to another site I will summarise what the writer said but put it in my OWN words. I will also post link below to the ECDC data the writer talked about so anyone can check out the statistics for themselves ( I did). So basically this comment was saying that historically there has been very few paediatric cases of MERS reported among the cases in Saudi Arabia ( according to WHO statistics children make up only about 3% of the MERS cases). 2 main ideas were touted. 1) Saudi Arabia were missing or even covering up child infections. 2) It was zoonotic and it tended to be adults that worked closer with the grumpy unpredictable but very valuable camels. Children were normally put to work with sheep, small cattle etc. However the comment writer then describes ongoing events in South Korea 700 miles from Saudi, and low and behold again very few children are reported being ill with MERS. ( WHO states only one child hospitalised.) So by comparing 2 data sets from 2 different countries similarities are beginning to emerge. ECDC have some good graphs on the data ( link below). So confirmation that pediatric cases are rare in South Korea, and seem also rare in Saudi Arabia. So 1) Saudi were probably not missing or covering up child cases of MERS. 2) As all of the MERS cases in South Korea are a result of human to human transmission and not the virus jumping from an animal host to humans, lack of exposure to infected camels may not be what is giving low paediatric numbers. Anyway I found the comments quite interesting, though the author didn't make any suggestions as to why cases of MERS in children are disproportionately low. I also thought it was a bit of a leap for the author to conclude that MERS was differentially infecting adults compared to children ( as we dont know if children are being infected and just reacting differently). So I thought I would ask you lot to take the observation further. Do you think the children are getting infected but being asymptomatic ? Is there any other infectious disease that causes severe illness in adults, but mild self limiting disease in children ? (Chicken pox, or mumps I guess they are totally different in severity in adults and children). Anyone any idea where the paediatric cases of MERS are ? Hzx Link showing age distribution of MERS cases. http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1244&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2Fhealthtopics%2Fcoronavirus-infections%2FPages%2Fnews_and_epidemiological_updates%2Easpx

cobber Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: August 13 2014 Status: Offline Points: 6035	Post Options Post Reply Quote cobber Report Post Thanks(0) Quote Reply Posted: July 07 2015 at 7:50pm
	We discussed this about a year ago. There are issues with the testing serums. There are two methods. I think both are a bit hit and miss. With both tests you have to wait for 12-14 days (there's a hint) from MERS symptoms for enough antibodies or enough virus to build up for detection to work. Basically you have to be very sick or had been very sick for it to detect. We have seen people tested several times only to be confirmed on the last test. So immunocompromised people get more sick and produce more antibodies or virus. They are being picked up in testing. People who are a little sick are not. You will notice that a lot of people getting sick have secondary conditions. Often lung issues. We concluded that there maybe a huge amount of people getting sick, but going under the radar. This information fits in perfectly with the confusing spread mechanism. There was much debate around bats , goats and finally camels. I don't think anyone now is denying this virus is human to human now.. Another interesting clue in the KSA health care workers were coming down with MERS quite often. Many recovered. I suspected they were diligently testing themselves (properly) where as a patient off the street would get the quick treatment, a slap on the back and out the door. I think testing method has a lot to play in the process. So to give some answers on your question. Almost certainly children are getting sick, but not enough to produce the virus in any great quantity and also not producing enough antibodies. There may also be other factors at play. Children may have a natural immunity to such a corona virus, such as the methods of viral attachment maybe hindered by the biology of youth. Its could also be a big conspiracy too :)