After a break of going 9 days without reporting any new MERS cases, the Saudi MOH reports two cases today, from two different cities; Jeddah & Jazan.
Other than their ages, and genders, and the fact that they aren’t healthcare personnel, we don’t get much information. Their mode of exposure is not indicated in this update.
While it is assumed that some small percentage of community acquired cases are the result of exposure to infected animals (primarily camels) or contaminated animal products, for the vast majority of community acquired cases we still don’t know how or where they were exposed.
The lack of contact with known infected individuals raises the question of whether transmission is occurring from mildly symptomatic (or asymptomatic) carriers of the virus. We know from limited testing of contacts of known cases that some percentage (roughly 20%) can be infected and show little or no outward signs of illness.
Although it seems likely that asymptomatic (or mildly symptomatic) cases are less infectious than patients with full blown symptoms - they still shed the virus - and so the possibility exists that they might serve as silent vectors of the disease in the community (see Study: Possible Transmission From Asymptomatic MERS-CoV Case).
Unfortunately, after nearly 2 years of waiting we still don’t have a comprehensive case-control study from the Saudis.
Which means that many aspects of how this virus spreads in the community remain largely unanswered.