Sunday, March 04, 2018

Saudi MOH Announces 7 MERS Cases Over 6 Days


Breaking a 6 day silence - and following media reports of a jump in cases (the topic of yesterday's blog) - the Saudi MOH overnight posted 6 days worth of updates (Feb 26th-March 3rd) adding 7 new MERS cases to their tally. 

Based on incomplete (only 16 days out of 28) and conflicting reporting last month, the MOH reported either 14 MERS cases in February (English page total) or 16 cases (Arabic page total).  
Hopefully we'll see some clarification from the next WHO update.
Going through the numbers we do have today, we see 7 new cases and 2 new deaths, along with indications of a growing nosocomial outbreak at a Riyadh hospital.

We'll start with the report from Feb 26th, with 3 cases all from Riyadh.  Two are listed as secondary HCWs.  In the week prior (Feb 17th-24th), the MOH had reported 9 cases, with 4 of those from Riyadh, making it difficult to determine which case sparked this healthcare related outbreak.

Moving on to Feb 27th, we get a single primary (no known risk exposure) case from Buraidah, already listed in critical condition.  One recovery (F,45) is also reported.

No cases were reported for the 28th, which brings us to the March 1st update, which adds another nosocomial (secondary hospital acquired patient) case from Riyadh, and a direct contact with camels case from Hail. Once again, both are in critical condition.

With no report for the 2nd, the final update is for March 3rd, where 1 new case (camel contact) is reported from Najran in the south of the country, along with 2 deaths and 1 recovery.

Like all disease surveillance and reporting systems, the Saudi MERS numbers we get almost certainly reflect a subset of the true burden of the disease.  Some cases are mild, moderate, or even asymptomatic, and may never be tested.
Others may have more severe disease - but since many cases are older and have comorbidities - they may be diagnosed with something else, or die without a diagnosis. 
We've seen estimates that only 40% of severe cases are correctly diagnosed (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016). So we try to look at these reports as trends, not absolute counts.

That said, consistency in reporting becomes paramount, as you can't deduce trends if the reporting quality changes from week to week, or year to year.
With nearly half of February's reports missing, discrepancies between the Arabic and English posts and case counts, and several `recoveries' announced without a corresponding initial illness report, it makes it difficult to say whether anything significant has changed with MERS in Saudi Arabia.
But based on the information we have, nothing immediately jumps out; community acquired cases still appear to be sporadic, and scattered across the Kingdom, with nothing suggesting increased community transmission.

We do seem to be seeing a moderate uptick in cases, particularly in and around Riyadh, and there is always the potential of seeing exported cases among international travelers (including religious pilgrims).
So we'll be watching the situation carefully, for any signs of escalation.
While the public's concerns over the international spread of exotic diseases like MERS-CoV, Ebola, and even Avian flu has waned somewhat over the past year or two, these threats  haven't gone away. 
Which is why every health care facility – large and small - needs to plan, train and equip themselves for the possibility that the next patient that comes through the ER entrance could be carrying something considerably more exotic and dangerous than seasonal flu.
For more, you may wish to revisit:

TFAH Issue Brief: Preparing The United States For MERS-CoV & Other Emerging Infections

HHS Launch A National Ebola Training & Education Center
Pandemic Unpreparedness Revisited

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