Sunday, May 24, 2015

WHO MERS-CoV Update – Saudi Arabia

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Saudi Arabia

 

 

# 10,082

 

We’ve been watching a growing cluster of cases from Hafuf (aka `Hafoof’, `Hafouf’,`Hufof;) which appears to have begun in mid-April (see here).  A second case – described as `a contact’ of the first was reported on May 5th.  Two days later 4 more cases described as `household contacts of a confirmed case’ were reported.


Since then, three more cases from Hafuf have been reported generically as `contacts’ of a previously confirmed case, the most recent coming yesterday.

 

What we don’t know is the relationship between these cases, the circumstances of exposure, and why new cases continue to pop up more than a month after the index case was first reported.

 

Although we’ve seen large nosocomial clusters of MERS infection previously, big household clusters are less common (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.), making the details of these cases of particular interest.

 

Today the World Health Organization has released an update with details on 12 recent MERS case – 5 of which belong to the Hafuf cluster – but that only states that these cases have `a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and on 29 April (case n. 2)’

Of the 7 other cases reported, 1 (in Jeddah) had direct contact with a previous case, 1 fell ill 10 days after entering a hospital (but also had camel contact), 1 (in Taif) fell ill while admitted to the same ward as another MERS case, 1 had frequent camel contact, and three others (from Riyadh) had no known risk exposures.

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

Disease outbreak news
24 May 2015

Between 11 and 13 May, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths.

Details of the cases are as follows:
  • A 66-year-old male from Qunfuthah city developed symptoms on 12 May while admitted to hospital since 3 May due to an unrelated medical condition. A nasopharyngeal swab tested positive for MERS-CoV on 14 May. The patient has 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.
  • A 31-year-old male from Hafouf city developed symptoms on 4 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 13 May. The patient is a smoker and has no comorbid conditions. He has a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and on 29 April (case n. 2). The patient has a history of frequent contact with camels and consumption of raw camel milk. He has no history of exposure to other known risk factors in the 14 days prior to onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 36-year-old male from Jeddah city developed symptoms on 10 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 11 May. The patient has no comorbidities. He has a history of contact with a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 17 May (case n. 3). The patient 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.
  • A 46-year-old, non-national male from Riyadh city developed symptoms on 25 April and was admitted to hospital on 9 May. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient has comorbidities. He has 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 stable condition in a negative pressure isolation room on a ward.
  • A 71-year-old male from Riyadh city developed symptoms on 3 May and was admitted to hospital on 6 May. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 33-year-old, non-national male from Riyadh city developed symptoms on 1 May and was admitted to hospital on 7 May. A nasopharyngeal swab tested positive for MERS-CoV on 9 May. The patient has no 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 isolation room on a ward.
  • A 33-year-old, non-national male from Riyadh city developed symptoms on 1 May and was admitted to hospital on 6 May. A nasopharyngeal swab tested positive for MERS-CoV on 8 May. The patient had no comorbidities. He passed away on 14 May. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 74-year-old male from Taif city developed symptoms on 9 May while admitted to hospital since 28 April due to an unrelated medical condition. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient had comorbidities. He was admitted to the same ward and treated by the same health workers as a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 17 May (case n. 3). The patient had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. He passed away on 10 May.
  • A 30-year-old female from Hafouf city developed symptoms on 4 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient has no comorbidities. She has a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and 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, she is in stable condition in a negative pressure isolation room on a ward.
  • A 59-year-old female from Hafouf city developed symptoms on 4 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient has comorbidities. She has a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and 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, she is in stable condition in a negative pressure isolation room on a ward.
  • A 24-year-old female from Hafouf city developed symptoms on 4 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. She has a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and 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, she is in stable condition in a negative pressure isolation room on a ward.
  • A 30-year-old male national from Hafouf city developed symptoms on 4 May and was admitted to hospital on the same day. A nasopharyngeal swab tested positive for MERS-CoV on 10 May. The patient has no comorbidities. He has a history of contact with two laboratory-confirmed MERS-CoV cases that were reported in previous DONs on 17 May (case n. 4) and 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, the patient is in stable condition in a negative pressure isolation room on a ward.

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

 


As we’ve discussed often in the past, sometimes the route of infection is pretty obvious, but most of the time we don’t really know how community-acquired cases were exposed (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps).

 

For more on this, you may wish to revisit The Community Transmission Mystery.

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