Sunday, May 17, 2015

WHO MERS-CoV Update – Saudi Arabia

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Saudi Arabia

 

# 10,058

 

The World Health Organization has published a Disease Outbreak News (DON) report on 5 recent MERS cases in KSA, one of which answers a question we’ve had about the index case of a recent cluster of cases in Hofuf, which now appears to have started almost a month ago.   

 

On April 20th we learned of a case in Hofuf, later described in the April 29th WHO DON as:

 

A 61-year-old male from Hafouf city developed symptoms on 16 April and was admitted to hospital on 18 April. The patient has comorbidities and a history of frequent contact with camels and sheep as well as consumption of raw camel milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.

 

Two weeks later (May 5th) we saw another announced case from Hofuf, which we now learn is a contact of the April 20th case (the following excerpt comes from today’s DON):

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A 39-year-old male from Hofuf city developed symptoms on 28 April and was admitted to hospital on 3 May. The patient is a smoker and has no comorbidities. He is a contact of a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 29 April (case n. 2). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.

 

This case is listed as `a contact’ of the April 20th case, although it doesn’t say what the relationship with the index case was.  Since then, we’ve seen 5 more cases from Hafuf listed at `household contacts of a confirmed case’ presumably all part of the same family cluster - although we have yet to see full epidemiological details on those.  

 

While we’ve seen larger nosocomial or community clusters of MERS infection in Saudi Arabia, this may represent the largest household cluster to date (see Community Case Clusters of Middle East Respiratory Syndrome Coronavirus in Hafr Al-Batin, Kingdom of Saudi Arabia: A Descriptive Genomic study by Z.A. Memish et al.)

 

It isn’t clear at this point if all seven these Hafof cases are all part of the same household, or perhaps the `household cluster’ only involves the six reported since May 5th.  Details that will hopefully be sorted out soon.

 

Of the other four unrelated cases reviewed in today’s release, two have no known risk factors, while two others have some level of exposure to camels or sheep (one, however is pretty weak).  While an opportunity for infection, exposure to livestock is no guarantee that was the source of infection.

 

As we’ve discussed often (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps), there remains a lot about how MERS spreads that we simply don’t fully understand, including the role of asymptomatic carriage and transmission of the virus.  

 

Anyone contemplating a visit to the region will want to review CDC Traveler’s Advice: Umrah, The Hajj and MERS.

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
17 May 2015

Between 4 and 9 May, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the cases are as follows:
  • A 75-year-old male from Abqaiq city developed symptoms on 30 April and was admitted to hospital on 3 May. He is an ex-smoker and has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in a negative pressure room on a ward.
  • A 61-year-old, non-national male from Najran city developed symptoms on 28 April and was admitted to hospital on 1 May. He had comorbidities. The patient had no history of direct contact with camels or consuming raw milk; however, he lived in an area with camels and sheep. The patient had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient passed away on 8 May.
  • A 48-year-old male from Taif city developed symptoms on 3 May and was admitted to hospital on 8 May. He has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
  • A 39-year-old male from Hofuf city developed symptoms on 28 April and was admitted to hospital on 3 May. The patient is a smoker and has no comorbidities. He is a contact of a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 29 April (case n. 2). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
  • A 41-year-old, non-national male from Huraimla city developed symptoms on 13 April and was admitted to hospital on 23 April. He has comorbidities as well as a history of frequent contact with camels and consumption of raw camel milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical in ICU.

Contact tracing of household contacts and healthcare contacts is ongoing for these cases.

Globally, WHO has been notified of 1116 laboratory-confirmed cases of infection with MERS-CoV, including at least 423 related deaths.

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