Thursday, July 30, 2015

WHO MERS Update – Saudi Arabia July 29th

Saudi Region

 

#10,373

 

 

The World Health Organization has published a new MERS update describing eight recent MERS cases, and their likely route of infection (if known).  All but one are from Riyadh City (#8 is from Hofuf), and three of the cases are listed as contacts or family members of known cases.  A fourth case (#3) is listed as a possible nosocomial infection.


Possible camel exposure is cited for three cases (including the Hofuf case), although only one case is listed as having actual camel contact.

 

Although it may well be probative, exposure to camels or camel products in the 14 days prior to onset of illness does not automatically lock that in as the actual source of infection. Despite growing Evidence for Camel-to-Human MERS-CoV Transmission, how often that actually happens is unknown.

 

Previously, we’ve seen estimates that only 3% of cases are caused by direct zoonotic infection (see Dr. Tariq Madani: 97% Of MERS Cases From Human-to-Human Transmission).Assumptions and numbers that must be taken with a sizable grain of salt, as we’ve yet to see the kind of case-control study to support them.

 

While repeated promises have been made regarding this type of study (see KSA Announces Start To Long-Awaited MERS Case Control Study), for whatever reason, we’ve yet to see the results.

 

Last May, in WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps we examined some of the glaring deficits in our understanding of this disease, a full three years after it first emerged in a Jordanian hospital.

 

Here then is the latest WHO update:

 

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

Disease outbreak news
29 July 2015

Between 16 and 25 July 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 8 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases
  • A 30-year-old male from Riyadh city developed symptoms on 22 July and was admitted to the hospital on the same day. The patient, who has no comorbidities, tested positive for MERS-CoV on 24 July. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 7 - see below). Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 28-year-old, non-national male from Riyadh city developed symptoms on 22 July and was admitted to the hospital on 23 July. The patient, who has no comorbidities, tested positive for MERS-CoV on 24 July. Currently, he is in stable condition in a negative pressure room. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 7 - see below). He has no history of dealing with or consumption raw camel meat. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 54-year-old, non-national male from Riyadh city developed symptoms on 20 July while admitted to hospital since 20 July due to unrelated chronic medical conditions. He tested positive for MERS-CoV on 22 July. Currently, the patient is in critical condition in ICU. Investigation of possible epidemiological links with laboratory-confirmed MERS-CoV cases who were hospitalized in the same hospital (case n. 5 – see below; case n. 2 – see DON published on 24 July) or with shared health care workers is ongoing.
  • A 52-year-old female from Riyadh city developed symptoms on 17 July and was admitted to hospital on the same day. The patient, who had comorbidities, tested positive for MERS-CoV on 21 July and passed away on 22 July. She was a family member of a laboratory-confirmed MERS-CoV case (case n. 5 – see below).
  • A 56-year-old male from Riyadh city developed symptoms on 13 July and was admitted to hospital on 15 July. The patient, who has comorbidities, tested positive for MERS-CoV on 19 July. Currently, he is in critical condition in ICU. The patient has a history of frequent contact with camels and consumption of their raw milk.
  • A 60-year-old female from Raniah city developed symptoms on 12 July and was admitted to hospital on 19 July. The patient, who has comorbidities, tested positive for MERS-CoV on 21 July. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient lives in an area with several camel farms; however, she has no history of contact with camels or consumption of raw camel products. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 32-year-old, non-national male from Riyadh city developed symptoms on 15 July and was admitted to hospital on 19 July. The patient, who has no comorbidities, tested positive for MERS-CoV on 20 July. Currently, he is in critical condition in ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 93-year-old male from Hofuf city developed symptoms on 12 July and was admitted to hospital on the same day. The patient, who has comorbidities, tested positive for MERS-CoV on 16 July. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient owns a camel farm; however, he has neither a history of contact with camels nor consumption of their raw milk. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.

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

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 MERS-CoV cases that were reported in previous DONs on 24* July (case n. 4) and on 23 June (case n. 2).

Globally, since September 2012, WHO has been notified of 1,382 laboratory-confirmed cases of infection with MERS-CoV, including at least 493 related deaths.

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