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A proposal by Professor Omar Hasan
Kasule Sr. MB ChB (MUK). M{H (Harvard), DrPH (Harvard)
1.0 PRIORITY AREAS OF RESEARCH
1.1 First Priority: Epidemiological Studies
1.1.1 Case control studies to refine the case
definition, describe the natural history, identify risk/susceptibility factors
of infection (sociodemographic, genetic, immunological, environmental,
behavioral, and co-morbidities)
1.1.2 Studies of time-space clustering of cases of
the disease to identify environmental factors
1.1.3 Identifying animal reservoirs/hosts and
working out the full transmission cycle
1.1.4 Risk factors of transmission to healthcare
workers and family members
1.1.5 Large sero epidemiological studies in the
general population and specific target populations such as animal handlers
1.1.6 Retrospective sero epidemiological studies on
stored serum and tissue samples to establish whether the virus or its variants
existed in the Kingdom before 2012
1.1.7
Study of the existing screening and diagnostic tests: sensitivity, specificity,
predictive value etc)
1.2 Second Priority: Immunization And Therapy
1.2.1 Virology: Sequencing the virus and
identifying virulence genes. Studying variations in viral properties (if any)
and their relation to virulence
1.2.2 Antiviral drugs: Basic and applied research on
rapid production of monoclonal antibodies (neutralizing and others) using genetic
engineering and other advanced technologies
1.2.3 Clinical studies: Clinical trials of existing
anti-virals like ribaflavin as well as interferons
1.3 Third Priority: Public Health Preventive Measures
1.3.1
Population based and hospital-based studies of knowledge, attitudes and
practices regarding preventive measures
1.3.2 Assessment
of compliance of hospitals and health care workers with MERS-Co guidelines
issues by the Ministry of Health
1.3.3
Assessment of the impact of public preventive measures undertaken since 2012.
2.0 BACKGROUND
2.1 The first case of MERS-Co was reported in
Jeddah in 2012[1]. Infection
has been confirmed to date in over 1000 patients about half of whom died from
the disease. The infection is severe requiring ICU admission with a high
mortality rate[2]. The
high mortality is due to co-morbidities, age above 65, low albumin, and male
gender[3],
[4].
2.2 The transmission cycle is not fully known. Spread
seems to be person to person either from family contacts or hospital contacts.
The majority of infections were reported from health care workers or other patients[5].
Transmission of the infection was relatively low in healthcare workers in
contact with infected patients[6]
as well as household contacts[7].
Finding of the virus in camels and their handlers suggested an animal reservoir
but this has not yet been proved conclusively[8], [9],
[10],
[11],
[12],
[13],
[14].
2.3 The Ministry of Health has undertaken many
measures to contain the infection inter alia public education, provision of
facilities for washing hands, surveillance etc. The infection shows seasonal
variations that may relate to patterns of human interactions, a reservoir host,
or virulent mutations. The virus seems stable[15],
[16]and
the epidemic cannot be due to virulent mutations.
2.4 Because of the large numbers of pilgrims who
come to Saudi Arabia every year, MERS-Co could become a world-wide epidemic.
There is an urgency to understand the epidemiological and virological aspects
of this infection in order to plan evidence-based prevention.
2.5 So far no antibiotic or vaccine has been
developed for the infection. Work is proceeding on monoclonal neutralizing
antibodies but there is no breakthrough yet[17],
[18].
Vaccine development faces obstacles of finding a suitable animal model. Pharmaceutical
companies are reluctant to invest in vaccine development because the number of
cases is so far too low[19]
to assure good returns on the investment.
2.6 There is
no effective treatment. Ribaflavin and interferon have not been proved yet to
be effective[20].
2.7 Available epidemiological, virological, and
clinical knowledge does not provide an adequate base of evidence-based
knowledge to plan effective public health measures. The Ministry has therefore
launched the present research effort in priority areas.
3.0 APPLICATION FOR AND AWARD OF
RESEARCH GRANTS
3.1
Initial submission
3.1.1 A 1-2 page concept paper identifying the
knowledge gap to be covered by the research, the objectives, the methods, the
time line, and a list of researchers with degrees and current positions.
3.1.2 The concept paper shall be sent to Ahmad Hersi
Chairman of the Science Advisory Board at MOH ahersi@moh.gov who will review and respond within one week whether a full
proposal should be submitted.
3.2 Final
submission
The full proposal shall be submitted using the KASCT forms
and following all KACST requirements for funded research.
3.3 Review
of the proposals
The proposals shall be referred to local and international
reviewers and a decision shall be made within 4-8 weeks.
3.4
Research awards
3.5.1 Research awards shall be from the Ministry of
Health under the authority of the Deputy Minister for Public Health; first
instalments shall be disbursed within 4 weeks of final approval.
3.5.2 KASCT guidelines will be followed in all
aspects of grant administration and follow up.
REFERENCES
[1]
Recent
Pat Antiinfect Drug Discov. 2015
Apr 8.
[2]
J Intensive
Care Med. 2015 Apr
9.
[3]
Int
J Infect Dis. 2014
Dec;29:301-6.
[4]
Int J Gen Med. 2014 Aug 20;7:417-23.
[5]
N Engl J Med. 2015 Feb 26;372(9):846-54.
[6]
Emerg Infect Dis. 2014 Dec;20(12):2148-51.
[7]
N Engl J Med. 2014 Aug 28;371(9):828-35.
[8]
Virus
Genes. 2015 Feb
5.
[9]
Recent
Pat Antiinfect Drug Discov. 2015
Apr 8.
[10]
Lancet Infect
Dis. 2015
May;15(5):559-64.
[11]
Emerg Themes
Epidemiol. 2015 Feb
18;12:3.
[12]
PLoS
Curr. 2014 Nov
24;6.
[13]
Virol
Sin. 2014
Dec;29(6):364-71.
[14]
Emerg Infect Dis. 2014 Nov;20(11):1821-7.
[15]
Clin
Infect Dis. 2015 Feb
1;60(3):369-77.
[16]
Trends
Microbiol. 2014
Oct;22(10):573-9.
[17] J Virol. 2014
Jul;88(14):7796-805.
[18] Proc Natl Acad Sci U S A. 2014 May 13;111(19):E2018-26.
[19] Expert Rev Vaccines. 2015
Apr 11:1-14.