Saudi MOH Reports 5th MERS-CoV Case In Buraidah For September

Buraidah Saudi Arabia

#13,523


Of the 10 MERS cases reported by the Saudi MOH during the first 19 days of September, half (n=5) have come out of Buraidah, and appear to involve - at the very least - a household cluster and a nosocomial transmission.

The scant information we get (which is frequently edited by the MOH, instead of appended to), makes it difficult to follow, but I've excerpted the 5 cases reported since Sept 1st below.

The first case (Sept 1st) reportedly had camel contact, while the second is simply listed as a `community acquired' case.  Case #3 is listed as secondary, hospital acquired while case #4 is listed as secondary, household contact.  Case # 5 is under investigation. 

Four of the 6 patients are listed as deceased, including the latest one added today.  There really isn't enough information here to determine whether these cases comprise 1 cluster or 2 clusters, or exactly where the first (camel contact) and 2nd (community acquired) cases fit in.

Meanwhile, in Riyadh, the MOH is reporting what appears to be a household cluster following an infection in a 44 y.o. male with recent camel contact.

By stressing better infection control, Saudi hospitals have managed to reduce  the number and size of hospital outbreaks of MERS significantly since 2015. 

But we've also recently seen doubts raised (see Evaluation of a Visual Triage for the Screening of MERS-CoV Patients) over how the Saudis conduct MERS surveillance and past research that suggests that many (perhaps most) MERS cases go undetected.

• In November of 2013, we looked at a study published in The Lancet Infectious Diseases, that estimated for every case identified, there are likely 5 to 10 that go undetected.
• In 2015, when Saudi Arabia had recorded fewer than 1200 MERS cases, a seroprevalence study (see Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study by Drosten & Memish et al.,) suggested nearly 45,000 might have been infected. 
• And a 2016 study (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016) suggested that as much as 60% of severe Saudi MERS cases go undiagnosed. 

While we obviously don't have a raging epidemic on our hands, MERS continues to jump to humans from camels, and spark small clusters of cases in humans. Each time it does so, it gets another opportunity to accrue host adaptations that might make it a more `humanized' pathogen. 

So we watch - as best we can with the sparse information provided - clusters like we're seeing in Buraidah, looking for any signs that MERS is getting its act together.

Last October, in Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia, we looked at an analysis that concluded that while MERS isn't ready for prime time, it may not have all that far to go.