The Saudi MOH is reporting two `mild’ MERS cases, albeit with `respiratory symptoms’ from Riyadh today. Of note, neither are listed as being contacts of confirmed or suspected cases.
How they were identified, or what their potential exposure to the virus might have been, is not disclosed. Additionally, 3 recoveries, and 1 death are reported today.
Since early August the Saudis have reported more than 170 MERS cases, most of which are linked to hospital outbreaks in the the nation’s capital. Included are more than 2 dozen healthcare workers.
A substantial number, however, are listed as not having `contact’ with known cases, or have cropped up in other locations, begging the question of how they were exposed.
While some may be the result of camel contact, that explanation is unlikely to apply to all of these community acquired `mystery’ cases. The role (and incidence) of `mild’ or asymptomatic carriage and transmission of the virus remains unresolved (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps).
Although the official start of the Hajj is still a week away, already hundreds of thousands of religious pilgrims from all over the world have converged on the Holy Cities, prompting public health officials around the globe to ramp up their preparations for the possible import of the virus when they return home.
A little over two weeks ago, the ECDC’s Updated Rapid Risk Assessment on MERS in light of Riyadh hospital outbreak warned:
Over 110 new cases and 30 deaths have been reported globally so far for August 2015 alone, almost all of them from Saudi Arabia. When compared to previous years, the increase in reported MERS cases in August is unexpected and is mainly explained by a large, ongoing outbreak linked to one Riyadh hospital.
The extent to which other healthcare facilities in Riyadh are affected is unknown, as is the number of asymptomatic individuals who may be infected with MERS-CoV.
The role of hospitals as amplifiers of MERS-CoV infection is well known, so the strict and timely application of comprehensive infection prevention and control measures is imperative.
Sporadic, imported cases can be expected in EU/EEA Member States, and is associated with a risk of nosocomial spread. This highlights the need for awareness among healthcare workers, early detection through functioning testing algorithms, preparedness planning and stringent infection control precautions.