WHO MERS Update – March 20th

Credit WHO

 

 

# 9849

 

The World Health Organization has released their latest MERS-CoV update, with details on 15 recent Saudi cases. As we’ve seen previously, many have no known risk exposures, while others appear to have contracted the virus while in the hospital (but often without direct contact with an infected case).

 

Of these 15 cases:

• 1 had contact with camels
• 1 had contact with people who had frequent contact with camels and camel products, but who were not sick
• 6 are community cases with no known risk exposures
• 1 is a community contact of a previously announced MERS case
• 2 are HCWs in facilities treating MERS cases, but without known or stated epidemiological links to a MERS patient
• 4 were patients in facilities treating MERS case, but without known or stated epidemiological links to a MERS case

 

As we’ve discussed previously (see The Community Transmission Mystery), while the source of some MERS infections are fairly obvious, for the vast majority we still don’t know how these patients were exposed.  

The lack of obvious epidemiological links to diagnosed cases raises the question of transmission of the virus from mildly symptomatic (or asymptomatic) carriers of the virus.  We know from limited testing of contacts of known cases that some percentage (roughly 20%)  can be infected and show little or no outward signs of illness. 

Whether these people can transmit the virus onward isn’t known, but we’ve seen some hints that it may be a factor (see Study: Possible Transmission From Asymptomatic MERS-CoV Case).

 

Three years after the first outbreak in Jordan (April 2012), and we still know depressingly little about the ecology and epidemiology of MERS-CoV.  These are questions that are usually resolved by conducting a comprehensive case-control study, where they compare laboratory-confirmed cases to a large number of controls, matched for age, sex, and by neighborhood.

 

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

 

Here are the highlights from today’s MERS GAR update.

 

 

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

Disease outbreak news
20 March 2015

Between 3 and 10 March 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 15 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 5 deaths. Cases are listed by date of reporting, with the most recent case listed first.

Details of the cases are as follows:

• A 72-year-old female from Buridah city developed symptoms on 23 February and was admitted to hospital on 2 March. She had comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient passed away on 9 March.
• A 61-year-old male from Riyadh city developed symptoms on 7 March while admitted to hospital since 22 February due to an unrelated medical condition. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases; investigation of epidemiological links with these cases and with shared health workers is ongoing. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
• A 48-year-old female from Riyadh city developed symptoms on 4 March while admitted to hospital since 19 January due to an unrelated medical condition. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases during the 14 days prior to the onset of symptoms; investigation of epidemiological links with these cases and with shared health workers is ongoing. Currently, the patient is in critical condition in ICU.
• A 37-year-old, non-national, male health worker from Riyadh city developed symptoms on 7 March and was admitted to hospital on 8 March. The patient has comorbidities. He works in a hospital where laboratory-confirmed MERS-CoV cases were treated during the 14 days prior to the onset of symptoms; investigation of epidemiological links with these cases is ongoing. Currently, the patient is in critical condition in ICU.
• A 48-year-old female from Riyadh city developed symptoms on 7 March and was admitted to hospital on the same day. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
• A 61-year-old male from Riyadh city developed symptoms on 27 February and was admitted to hospital on 5 March. The patient had comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient passed away on 9 March.
• A 57-year-old male from Hafouf city developed symptoms on 4 March and was admitted to hospital on 6 March. The patient has no comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
• A 56-year-old male from Riyadh city developed symptoms on 4 March and was admitted to hospital on 5 March. The patient has comorbidities. He is a contact of a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 11). He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
• A 48-year-old, non-national, female health worker from Riyadh city developed symptoms on 3 March and was admitted to hospital on 5 March. The patient has no comorbidities. She works in a hospital where laboratory-confirmed MERS-CoV cases were treated during the 14 days prior to the onset of symptoms; investigation of epidemiological links with these cases is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
• A 59-year-old female from Khurmah city developed symptoms on 23 February and was admitted to hospital in Jeddah on 28 February. The patient has comorbidities. She has no history of direct contact with camels; however, her household contacts have history of frequent contact with camels and consumption of raw camel milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, she is in critical condition in ICU.
• A 53-year-old male from Riyadh city developed symptoms on 3 March while admitted to hospital since 13 July 2014 due to an unrelated medical condition. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases during the 14 days prior to the onset of symptoms; however, he had no direct contact with these cases. The patient had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. He passed away on 5 March.
• A 44-year-old, non-national male from Shaqra city developed symptoms on 23 February and was admitted to hospital on 25 February. The patient has no comorbidities. He has a history of frequent contact with camels and consumption of raw camel milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
• A 30-year-old, non-national male from Onizah city developed symptoms on 2 March and was admitted to hospital on the same day. The patient had no comorbid conditions. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient passed away on 8 March.
• A 69-year-old female from Riyadh city developed symptoms on 3 March while admitted to hospital since 20 February due to an unrelated medical condition. The patient was admitted to the same hospital as other laboratory-confirmed MERS-CoV cases during the 14 days prior to the onset of symptoms; investigation of epidemiological links with these cases and with shared health workers is ongoing. She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
• A 70-year-old female from Riyadh city developed symptoms on 24 February and was admitted to hospital on 25 February. The patient had comorbidities. She had no history of exposure to known risk factors in the 14 days prior to the onset of symptoms. The patient passed away on 4 March.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 5 previously reported MERS-CoV cases. The cases were reported in previous DONs on 11 March (case n. 8), on 6 March (case n. 5) and on 23 February (cases n. 36, 38) on 16 February (case n. 2).

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

Globally, WHO has been notified of 1075 laboratory-confirmed cases of infection with MERS-CoV, including at least 404 related deaths.

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