Friday, January 26, 2018


EMRO Update - Dec 2017


Those who follow daily MERS reports out of the Middle East are aware that information is relatively sparse and sometimes released belatedly by the Saudi MOH, and that we are highly dependent upon the WHO summaries that are published later to fill in the gaps.
As you'll see, sometimes even those summaries don't always agree.
According the the Saudi Daily Reports, they announced 8 cases in December, although since they don't provide onset or diagnosis dates, we often don't know exactly when these cases were first discovered.  
A couple of days ago the World Health Organization's Eastern Mediterranean Regional Office (EMRO) released a new graphical update on MERS cases (see above), which cited 6 global cases of MERS-CoV  - only four of which were from Saudi Arabia - during the month of December.
MERS situation update, December 2017

  • At the end of December 2017, a total of 2127 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV), including 757 associated deaths (case–fatality rate: 35.6%) were reported globally; the majority of these cases were reported from Saudi Arabia (1753 laboratory-confirmed cases, including 683 related deaths with a case–fatality rate of 38.9%).
  • During the month of December, 6 laboratory-confirmed cases of MERS were reported globally as follows- 4 cases in Saudi Arabia including one associated death, one case in United Arab of Emirates and one case in Malaysia. No health-care associated transmission or hospital outbreak was reported during this month.
  • The demographic and epidemiological characteristics of the cases reported in 2017 do not show any significant difference compared with cases reported during the same period from 2012 to 2016. Owing to improved infection prevention and control practices in the hospitals, the number of hospital-acquired cases of MERS has dropped significantly in 2015 and in 2016 compared to previous years.
  • The age group of those aged 50–59 years continues to be the group at highest risk for acquiring infection as primary cases. For secondary cases, it is the age group of 30–39 years who are mostly at risk. The number of deaths is higher in the age group of 50–59 years for primary cases and 70–79 years for secondary cases.

And in today's first WHO Disease Outbreak News report from KSA since December 19th, we learn that 9 cases were supposedly reported to them during the month of December (see below)

Although I'm at a loss in explaining the large disparity between the EMRO and WHO DON numbers, minor discrepancies I suspect can be chalked up to delays in reporting, different cut off dates for reports, and possibly differences in the date used (onset of symptoms vs hospitalization or notification date) for categorizing cases. 

Today's WHO DON has a cut off date of January 17th, and since then we've seen several more cases reported by the Saudi MOH.  

Regardless how we count the number of cases in December, we've seen a noticeable uptick in cases since the first of the year (n=17), and that could go even higher as we've not seen a Saudi MOH update in 3 days.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
26 January 2018

Between 9 December 2017 and 17 January 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 20 additional cases of Middle East Respiratory Syndrome (MERS), including eight deaths. In addition, one death from a previously reported case was reported to WHO.
Details of the cases

Detailed information concerning the cases reported can be found in a separate document (see link below).
MERS-CoV cases reported between 9 December 2017 and 17 January 2018 xls, 227kb

The 20 cases of MERS-CoV infection reported during this time period are from 11 areas of the country. The reported cases range in age from 28 to 89 years old, and five of the 20 report direct or indirect contact with dromedary camels. One patient was admitted to hospital for other conditions prior to symptom onset. See MERS-CoV maps and epicurves
Public health response

The source of infection for each case reported is under investigation by the Ministry of Health and Ministry of Agriculture (when dromedaries are involved) in Saudi Arabia. The Saudi Arabian Ministry of Health has identified and is following up contacts, including health care worker and household contacts, of known MERS patients.

Globally, 2143 laboratory-confirmed cases of infection with MERS-CoV including at least 749 related deaths have been reported to WHO.
WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

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