Sunday, January 21, 2018

Saudi MOH: 3 New MERS Cases


Daily MERS-CoV reporting from the Saudi MOH continues to be a bit erratic, with updates sometimes posted belatedly, and the English language page occasionally missing reports that are posted on the Arabic page. 
Six days ago, in Saudi MOH Reports 1 New MERS Case & 3 Deaths, I reported on an update for January 13th that appeared on the Arabic list, but not on the English list. That data remains absent on the English language report.

Today the Arabic list shows 3 more MERS cases over three days (18th, 19th, 20th) while the English language list only shows 2 cases (18th & 20th).  It is possible this third case will be added to the English side in the next couple of days.
In any event, between the two lists we have 3 more cases, bringing January's reported total to 16 cases and 11 deaths.
The first case, reported yesterday, is of a 60 y.o. female in critical condition from Al Quryat, is dated the 18th,  and is listed as a primary case (no listed risk exposure).
The second case, dated the 20th on the English list - is dated the 19th on the Arabic list.  This one is a 58 y.o. male from Najran - also a primary case with no risk exposure - listed in stable condition.

The Arabic report for the 20th also appears to be a primary case from near Buraidah.  Since it is in graphic form, translation software won't decipher the details.

Although reports were slow during the month of December, we've seen an uptick in cases since the first of the year.  Of the 16 cases we are aware of in 2018, 3 have been linked to recent camel exposure, 12 are primary (community acquired), and 1 was a secondary HCW exposure.

Exactly how these community acquired cases arise remains a bit of a mystery, although sporadic community transmission from mildly ill or asymptomatic carriers is considered a possibility.
We saw a 2016 study (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016) suggesting that as much as 60% severe of Saudi MERS cases go undiagnosed. A 2013 study published in The Lancet Infectious Diseases, that estimated for every case identified, there are likely 5 to 10 that go undetected.
The last WHO EMRO MERS report was for the month of  November, while the last WHO GAR update on MERS was published on December 19th, but only current to December 8th.

Despite this recent uptick, and gaps in the data, the good news is we've seen no signs of any sustained or efficient transmission of the MERS virus outside of health care facilities.
That said, there have been some signs suggesting the MERS virus has gotten a little better at transmitting in the community (see Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia).
So we keep watch on these reports for any signs that the status quo has changed.

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