Yesterday there were 732 MERS cases reported by the Saudi MOH, and today that number climbs to 748: all stemming from of an audit of cases from before June 3rd of this year, and mostly arising from Jeddah.
While 19 cases were added to the tally - 1 duplicate case, and 2 false positives were removed - resulting in a net gain of 16 cases.
While the number of identified MERS cases has remained reassuringly stable over the summer, earlier studies have suggested that the bulk of those infected - being either mildly ill, or asymptomatic – are never identified. Given the apparent seasonality of MERS we would need to get through an entire winter-spring cycle without seeing a spike in cases before attaching too much significance to this pause.
Despite the somewhat self-congratulatory tone of this press release, we continue to see only the bare minimum of information released on recent cases out of Saudi Arabia, and we’ve yet to see results from the long-promised case control study (see KSA Announces Start To Long-Awaited MERS Case Control Study).
JEDDAH 18 September 2014. The Ministry of Health released information today about 19 historical (old) cases of MERS-CoV, as part of an ongoing review of patient data. Each of these cases had a date of onset prior to 3 June, 2014.
Since launching a comprehensive response to MERS-CoV earlier this year, the number of reported cases in Saudi Arabia has declined dramatically.
Other aspects of MoH response include public health education, new procedures and equipment to quickly identify and treat patients and promotion of best practice to prevent the spread of MERS-CoV between healthcare workers.
The new information was discovered during an ongoing validation process designed to ensure the accuracy of MERS-CoV historical infection data. The review, undertaken by an independent auditor, is part of MoH’s effort to minimize data discrepancies, with the goal of capturing information that enables healthcare workers to better control the disease.
MoH is conducting a retrospective analysis that includes a case-by-case review to better understand how to capture patient data in a more timely and complete way. It has also stepped up efforts to communicate to healthcare workers the requirement for quick and accurate reporting of infectious disease information. The new data has been shared with the World Health Organization.
Many of the additional cases were identified through a review of patient records at hospitals that perform on-site laboratory testing. All but three of the cases were in Jeddah.
Further revisions to the overall MERS-CoV statistics include:
1. The status of 18 cases was changed from active to recovered, while the categorization of three cases was changed from active to deceased
2. One duplicate case was identified and deleted
3. In addition, two cases reported 9 June and 26 August, were subsequently identified as a false positive and have been removed from the statistics.
This effort complements the on-going implementation of the Health Electronic Surveillance Network (HESN), a comprehensive, integrated public health information system that helps public health workers collaborate to manage individual cases, outbreaks, immunizations, and medical inventories. Regular reviews are part of the MoH effort to introduce internationally accepted standards for due diligence, and can result in changes to reporting statistics arising from reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance outcome.
In total, MoH had identified 748 laboratory-confirmed cases of MERS-CoV as of 18 September, 2014.
Update: Shortly after posting this blog I found the Dr. Ian Mackay on his VDU blog has written an open letter to the Saudi MOH requesting the release of additional information on MERS cases. Follow the link to read:
From: Ian M Mackay
To: The Office of the Minister of Health, Kingdom of Saudi Arabia
I write to humbly ask for your help on a matter of infectious disease communication. I ask that you please consider completing the already near-complete public data picture for all retrospectively confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) that have occurred on your soil. I ask that this be publicly released for analysis, and suitably acceptable citation, by all. The Ministry of Health has already made a number of advances in tracking and communicating new cases of MERS-CoV, addressing criticisms along the way. But there remain some small but epidemiolgically important gaps in an otherwise complete set of data that could be easily closed.