Saudi MOH: 1 New MERS Case In Taif

 

# 10,093

 

Although Taif was the site of extensive MERS activity last fall (see Saudi MOH Reports Another MERS Case From Taif), we’ve only seen a few scattered reports from that city over the past few months.

 

About 10 days ago we learned that a 48-year-old male from Taif city – without a known risk exposure - developed symptoms and was admitted to hospital on May 8th.  This past Sunday we saw another report detailing a 74-year-old patient who tested positive nearly two weeks after being admitted to a hospital for another condition. 

 

The WHO report indicated `he was admitted to the same ward and treated by the same health workers as a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 17 May’ .

 

Today we’ve now a  third reported case from Taif, although the barebones report posted on the MOH website provides few clues as to whether it is related to either of the previous two cases.

Saudi MOH Announces 1 New MERS Case In Hafuf (Plus 2 Fatalities)

 

# 10,087

 

The cluster of MERS cases in Hafuf (aka `Hafoof’, `Hafouf’,`Hufof;) over the past month has risen to 11.  The index case – described by the WHO as:

 

A 61-year-old male from Hafouf city developed symptoms on 16 April and was admitted to hospital on 18 April. The patient has comorbidities and a history of frequent contact with camels and sheep as well as consumption of raw camel milk.

 

Since then (starting May 5th) we’ve seen a steady procession of 10 additional cases, all described as `contacts of a previously suspected or confirmed case’, come out of Hafuf.   Some were described as household members, for others the relationship was not specified.

 

Unfortunately, whatever the specifics are behind this prolonged chain of MERS infections, the Saudis aren’t saying. 

Saudi MOH: 1 More MERS Case In Hafuf

 

# 10,085

 

The MERS cluster in Hafuf (aka `Hafoof’, `Hafouf’,`Hufof;) which we looked at in some detail earlier today (see WHO MERS-CoV Update – Saudi Arabia) continues to grow more than a month after the first case was identified, with the 10th case reported in today’s MOH update.

 

While some of these cases have been described as `household contacts’, other are simply described as `contacts’ of previous cases, leaving us with no real sense as to whether this is primarily a family cluster, or if this has evolved into a nosocomial cluster as well.

Saudi MOH: Another MERS Case In Hafuf

# 10,080

 

While details remain very sketchy, the month-long saga of (apparently epidemiologically related) MERS cases in Hafuf continues with the 8th case reported from that region since May 5th, and the 9th since April 20th. 

Saudi MOH: 1 New MERS Case (Hafuf Again)

 

# 10,072

 

After two days without reporting any cases we learn of yet another case from the town of Hafuf, which has been the site of repeated – apparently epidemiologically related – cases over the past month.   The first case was reported on April 20th, followed by another case on May 5th reported to be `a contact’ of the first case.

Exactly how and when this contact occurred wasn’t specified. Since then, we’ve seen 5 more cases from Hafuf listed at `household contacts of a confirmed case’ – although exactly which of these first two patients (or both) they are related to isn’t clear.

 

Today we’ve another case listed (even more generically) as a `Contact of a suspected or confirmed case in the Community or Hospital’.    We also don’t get onset dates, further clouding the issues.

In any event, this appears to be the 8th case from Hafuf (aka `Hafoof’) over the past 30 days, all of which appear to stem from the index case reported on April 20th.

Hopefully we’ll get a WHO report that can sort out the epidemiological chain of events behind these cases for us.

Saudi Weekly MERS Summary

Coronavirus – Credit CDC PHIL

 

# 10,059

 

 

When the Saudi MOH posts their parsimonious daily MERS reports they offer a consolation prize of sorts, a promise that `More information on the exposure history will be posted on the weekly update’.  The reality of these weekly MERS updates has been underwhelming in the past. 

 

They generally cite some dry statistics on how many people they’ve tested, how few have actually tested positive, and remind us what a good job the MOH is doing.

 

With a sudden uptick in MERS cases (n=12), half of those appearing to stem from a large family cluster in Hofuf (along with a recently installed Health Minister at the helm), I had faint hopes this week’s installment would mark a change, and we’d actually get `more information on the exposure history’ of the Hofuf cluster.

 

Unfortunately the cookie cutter statement format we’ve seen for months remains intact.  

 

(machine translated)

(Health) recorded 12 cases of B (CK) during the past week

28 Rajab 1436

Ministry of Health said in a statement that the weekly number was recorded 12 confirmed cases of infection (Corona) throughout the past week in: Hofuf, Taif, Riyadh, Jeddah, and Qunfudah, And during the period from 21 July to 271 436 H, corresponding to 10 to 16 May 2015 m (International Week 20).

The ministry said that although the number of cases is still less than what was recorded in the same period of last year, but it has been observed that the number of cases has increased compared to the week, which was accepted; therefore the ministry confirms the continuation of preparations as they are, and that efforts must continue cooperation All parties, especially the cooperation of community health workers, who represent the main pillar in the face of the disease.

The ministry showed that in 1380 were examined a sample of virus (Corona) in the laboratories of the Ministry of Health during the same period. The number of public health teams in contact visits to 12 positive cases amounted to visit. The number of visits to the Ministry of Agriculture also reached two visits, while the ministry's efforts in health education segments of society continued through the awareness campaign virus (Corona) (appreciate plugged). As it confirmed healing 552 infected cases (La Coruna), thankfully at a rate of 55.3%, from a total total number of confirmed cases and 999 of the case.

And it continues to command and control center at the Ministry of Health efforts around the clock, through carrying out epidemiological surveillance, and to ensure the commitment of all public and private health facilities to apply infection control procedures, as well as coordination with relevant government sectors and international health organizations, including the WHO and the houses of the Organization of experience to follow What about all emerging virus (Corona). The ministry also continue its efforts and fully coordinated with the Ministry of Agriculture to carry out awareness campaigns virus (Corona) in places camels gathered and contacts from her owners and breeders to be cautious and taking the causes of prevention when dealing with camels

 

While I’d like to be able to report that these sorts of vague, candy-coated updates are unique to the Saudi MOH, the truth is I see these sorts of tactics used every day on agency websites around the world – including many in the United States.  

 

I suspect there is a university somewhere churning out public information officers with a degree in saying nothing with the greatest possible number of words.

 

The good news is, the World Health Organization has managed to fill in many of these missing details in their updates in the past. With a little luck we’ll have a better feel for how the Hofuf cluster played out in the next couple of weeks.

Saudi MOH Coronavirus Website Back Up

 

# 10,055

 

Yesterday, in KSA: A Sudden Dearth Of MERS Data, I wrote about the recent glitches on the Saudi’s coronavirus website, their abrupt moving of daily (truncated) MERS updates to wecanstopthis.com, and my fervent hopes that this was just a temporary measure while they fixed their website issues.

 

I’m pleased to report that the Saudi’s Coronavirus Command & Control Center is back up and running, they appear to be actively updating it, and we now have the case tables for the three cases reported on May 12th & 13th. 

 

May 13th

 

 

May 12th

 

The May 13th case in Hufof is the 7th case from this region since April 20th,  and the 6th since May 5th.  The last five have all been described as `household contacts of a confirmed case’, suggesting this one of the largest household clusters we’ve seen.

 

The May 12th case from Jeddah is also listed as a household contact of a confirmed case, which is a bit curious, as we’ve not seen a case reported out of Jeddah in many weeks.  Hopefully we’ll get some clarification on this chain of infection in either their weekly report, or the next WHO update.

 

While the level of detail we get from these tables leaves a lot to be desired, after three days without them, their return is welcome indeed.

Saudi MOH: 9 New MERS Cases

 

# 10,035

 

With the recent shuffling at the head of the Saudi MOH, and a corresponding dramatic drop in the reporting of MERS cases out of that nation, there’s been some speculation that perhaps surveillance and reporting might be lagging over the past couple of weeks.   

 

After five weeks (April 1st-May 6th) with only 11 cases reported, we’ve seen 12 new cases announced (see Saturday’s Saudi MOH Reports 3 MERS Cases) over the past three days. 

 

Since onset dates are left out of these reports we have no way of knowing  exactly how `old’ any of these cases are, but 4 cases are listed as a `family contact’ of a previous case in Hufof – presumably the case reported on May 5th – although another case was reported from Hufof on April 20th.   So either (or perhaps both) are a possibility.

 

Meanwhile, there is a nosocomial transmission reported in Taif, and 4 more cases in Riyadh.  It will be very interesting to see what the parameters are of the apparent cluster in Hufof when the WHO published their report.

 

Hopefully this is the MOH playing catch up, and not a sign of a new surge in cases.

Saudi MOH Reports 3 MERS Cases

 

# 10,031

 

After a remarkable (and unexpected) lull in MERS cases for the past 30 days, we’ve an abrupt uptick today with three cases reported across three different cities of Saudi Arabia.

 

Details, as always, are scant.  From the table it appears that none are HCWs, and no known exposure risks are noted.

 

 

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. 

 

These are questions that are usually resolved by conducting a comprehensive case-control study, where epidemiologists 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.

Saudi MOH Reports 2 MERS Cases

# 9959

The number of MERS cases reported by the Saudi MOH remains far lower than expected, with just 8 cases reported thus far in April. 

 

WHO MERS-CoV Update – April 16th

Credit Saudi MOH

 

 

# 9950

 

Although the number of case reports coming out of Saudi Arabia has slowed markedly in the past couple of weeks, we continue to see sporadic cases emerge, many without a clear exposure risk. 

 

Yesterday’s World Health Organization update lists  4 recent cases - 1 of which is a HCW with contact with a known MERS case -  but exposure risks for the other three remain unknown.

 

First the WHO update, after which I’ll return with a bit more.

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
16 April 2015

Between 2 and 12 April 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths. Cases are listed by date of reporting, with the most recent case listed first.

Details of the cases are as follows:

• An 82-year-old male from Hail city developed symptoms on 26 March and was admitted to hospital on 2 April. Since the patient did not show signs of improvement, he was transferred to a hospital in Riyadh city on 4 April. The patient, who had comorbidities, passed away on 12 April. Investigation of contacts in the 14 days prior to the onset of symptoms is ongoing.
• A 65-year-old female from Riyadh city developed symptoms on 3 April and was admitted to hospital on the same day. The patient, who had comorbidities, passed away on 5 April. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 66-year-old, non-national male from Makkah city developed symptoms on 27 March and was admitted to hospital on 3 April. The patient visited a private health centre for an unrelated medical condition on 1 April. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
• A 51-year-old, non-national, male health worker from Jeddah city developed symptoms on 28 March and was admitted to hospital on 29 March. The patient has comorbidities. He has history of contact with a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 9 April (case n. 3). The patient did not provide care to any of the MERS-CoV cases that were admitted to the hospital where he works in during the 14 days prior to the onset of symptoms. 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.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 3 previously reported MERS-CoV cases. The cases were reported in previous DONs on 9 April (cases n. 2, 5) and on 20 March (case n. 14).

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

Globally, WHO has been notified of 1106 laboratory-confirmed cases of infection with MERS-CoV, including at least 421 related deaths.

(Continue . . . )

 

Since the 1st of April the Saudi MOH has only announced 5 new MERS cases, a remarkable reduction from this time last year when KSA was embroiled in their largest outbreak on record (see chart below).

 

Credit WHO EMRO MERS Summary

 

Why, after a strong start, this year has (thus far) played out differently is unknown.  Better infection control practices in hospitals may be a factor, and it is possible that the warnings regarding avoiding camel contact are being heeded.

But since we lack a clear understanding of how the virus is spreading in the community, there may well be other factors at work here we simply haven’t recognized.

 

Normally we’d get answers to these questions from a case-control study, where epidemiologists would compare laboratory-confirmed cases to a large number of controls, matched for age, sex, and by neighborhood. By examining their respective exposures against their outcomes, patterns of risk are often revealed.

 

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

 

While this lull in MERS cases may not last, for now it is a welcome respite given the number of other emerging disease threats we are monitoring around the globe.

Saudi Arabia: 1 MERS Case In Mecca

 

# 9936

 

After four days without a reported MERS case from Saudi Arabia, their MOH has announced a single case in the city of Mecca.  Other than his gender, age, and being in critical condition, little additional information is provided.

 

After a strong start to 2015, and the spectacular spring surge of MERS cases in 2014, it is a bit surprising that the number of cases being reported right now has dropped as low as it has.  

Some credit may go to better infection control practices in healthcare facilities, which were a major focal point for outbreaks last year. 

 

However welcome, until we better understand how MERS is being transmitted in the community (and why this slowdown has occurred), this recent reduction in cases can only offer temporary comfort. 

Saudi Arabia Replaces Minister Of Health (Again)

Saudi Arabia

 

# 9928

 

It was just shy of a year ago that long-serving  Minister of Health  Dr. Abdullah Al-Rabiah  was abruptly replaced by Dr. Adel bin Mohammed Faqih (see Saudi Minister Of Health Replaced), presumably over the Ministry’s lack of progress in controlling the MERS outbreak.

 

Dr.Faqih’s reign ended in early December (see Saudi King Appoints New MOH Amid Sweeping Changes To Ministries), with the instatement of Dr. Muhammad Bin Ali Al-Hayazie as head of the Health Ministry.

 

In January we saw signs of a scandal at the MOH emerge when it was revealed that the MOH Canceled Coronavirus Contracts Over Corruption Allegations.  Exactly who was involved, or to what extent, wasn’t abundantly clear from the coverage. 

 

Two days later, however, Saudi King Abdullah bin Abdulaziz died while hospitalized for a lung infection, and within a week the new king -  Salman bin Abdulaziz  – announced a Massive Cabinet shake-up.

 

Six weeks into his tenure Dr. Muhammad Bin Ali Al-Hayazie was out, and Ahmed bin Aqeel Al-Khatib  was installed as the kingdom’s new Health Minister.

 

Late last night,  the Saudi’s announced that after 10 weeks, Ahmed bin Aqeel Al-Khatib  has been relieved by royal decree. This from the Saudi Press Agency

 

Royal Order relieves Health Minister of his post, and appoints Mohammed bin Abdulmalik Al Al-Sheikh, Acting Health Minister

Riyadh, Jumada II 22, 1436, April 11, 2015, SPA -- The Custodian of the Two Holy Mosques King Salman bin Abdulaziz Al Saud issued yesterday a royal order relieving Ahmed bin Aqeel Al-Khatib, the Minister of Health, of his post, and appointing Minister of State and Cabinet's Member Mohammed bin Abdulmalik bin Abdullah Al Al-Sheikh, as Acting Minister of Health.

The competent authorities shall implement this royal order.

 

The official announcement doesn’t tell us much, but an Al Arabiya article published overnight suggests this was the result of a public relations incident involving the Health Minister and a citizen, which was caught on tape.

 

Saudi health minister sacked after leaked video shows heated row

By Staff writer | Al Arabiya News
Saturday, 11 April 2015

A recently leaked video involving a Saudi minister in a squabble has been a hot topic in the kingdom.

Health minister Ahmed Khatib was filmed having a heated argument with another citizen, in which he was shouting and making angry gestures.

Former Saudi Health Minister Ahmed Khatib. (Al Arabiya)

He was later relieved of his duties in an order by Saudi King Salman bin Abdulaziz on Friday, with Dr. Mohammed Ali al-Sheikh appointed Acting Health Minister of Saudi Arabia.

(Continue . . . )

 

I’ve watched the video, but without subtitles all I can say is it appeared `heated’, and according to media reports has gone `viral’. 

 

I’ll leave it to those with a better grasp of the Arabic language and the Saudi political landscape to opine as why such swift action was taken, although I suspect the dreaded phrase `Arab spring’  probably figured into their decision making.

 

The end result is that Dr. Mohammed Ali al-Sheikh becomes the 4th Saudi Minister of Health to serve in less than 12 months, and the government agency with the best chance of stopping the spread of the MERS coronavirus finds itself once again under new management.

Saudi MOH: 1 MERS Case In Hail

 

 

# 9918

 

This time last year we were beginning to see the start of what would turn out to be an explosion of MERS cases in Saudi Arabia, a spike that would see more than 500 people infected in just over a 2-month period.   As the chart above shows, we saw an early peak in late February, and since then a fairly steady decline.

 

We’ll have to wait to see if another spring surge is in the offing.

 

In the meantime, after three days without a new case, we have this report of a single case in Hail.

 

Saudi MOH: 2 New MERS Cases

# 9902

 

After a couple of quiet days, the Saudi MOH is back with two new MERS Cases; one in Riyadh and the other in Mecca.  No known exposure risks are listed for either of these cases.

 

Saudi MOH: 2 New MERS Cases & Weekly MERS Statement

 

# 9882

A subtle change (again) to the daily reporting comes with the combining of suspected or confirmed contacts in both  the community and healthcare setting.  Two weeks ago, suspected nosocomial contacts were abruptly dropped from the chart without explanation, but are now apparently lumped in with community exposures.  

 

While the daily case graphic promises that `More information on the exposure history will be posted on the Weekly update’,. there is actually very little case-specific information to be gleaned from the following (translated,and syntax challenged) report except . . . all appear to be ex-pats.

 

How and why they came to be infected isn’t really addressed, although 2 cases appear to be household contacts.  We will hopefully get more information in the next WHO report.

 

Health weekly statement issued and recorded 8 cases last week

10 April 1436

A continuation of the Ministry of health to inform everyone on the developments of the Middle East respiratory syndrome Corona

The Department of Health announces that from 2 to 8 Rajab 1436 e was recording 8 confirmed cases infected with coronavirus, aged 20-65 years, including three in Riyadh and one in both Jeddah and Makkah, Najran and Taif and the northern border and the nationality as follows (EUR 3, Yemeni1, Filipino 1, Pakistan 1, 1 Sudanese, Bangladeshis 1) including 7 male and 1 female.

The Ministry has shown that the registry as established healthcare facilities were observed for 4 cases, while the last four spotted in private enterprises.

The Ministry confirmed that the recording of cases of infection were in Makkah, Najran and Jeddah and Arar tayv of society while recording the number 2 if contacts home and number 1 one case under investigation.

The rapid response teams to combat infection health facilities had about 16 field trip between visits and visits to append last week

As preventive medicine teams visit the 9 homes and been limited to 102 contacts are being followed home until the incubation period for the virus.

The Ministry said that the number of communications that are initiated from the Agriculture Ministry teams (including follow-up to previous cases had direct contact with camel 2 communications in both Mecca and tayv).

The Ministry stressed that the command center which continues its efforts around the clock through the epidemiological surveillance and ensure the commitment of all Government and private health facilities to implement infection control measures and coordination with concerned government sectors and international health organizations, including the World Health Organization and expertise to follow all committed for the coronavirus.

Saudi MOH: 3 MERS Cases, 2 Fatal

 

# 9880

 

After a two-day lull, the Saudi MOH is back with three new MERS cases, two of which are already listed as deceased.  Given the recent reduction in case information being presented in these daily updates, we’ll need to wait for a WHO update to get some sense as to how they were exposed.

 

Saudi MOH: 2 New MERS Cases

# 9869

 

Saudi MOH: Fines And/Or Prison For Failure To Report MERS Cases

Saudi Arabia

 

# 9862

 

Although it boggles the mind that this should be an ongoing problem, apparently the Saudi MOH is concerned that health practitioners are still not reporting all MERS cases to the Ministry of Health – essentially covering up cases.  

 

Last month it was widely reported in the Saudi press that Hospitals that do not report MERS cases would be shut down, with the the ministry undersecretary for general health warning:

“Fines of up to SR100,000 will be imposed on the facilities and on health practitioners who conceal cases, do not report them or do not take the necessary measures to prevent the spread of the disease.” - Abdul Aziz Bin Saeed

 

Now, based on a statement posted today on the Saudi MOH website, a prison term of up to 6 months can be tacked on for failure to report as well.

 

Prison and a fine b (100) thousand riyals for not reporting injuries (Corona)

05 June 1436

From the keenness of the Ministry of Health to improve the work in health facilities, and to ensure the reduction of the spread of the virus (Corona) that causes respiratory syndrome, the Middle East, The ministry has stressed the need for the health practitioner's commitment to including issues of the decisions and instructions governing the reporting of infectious diseases, and are reported to the competent authorities, directly or through an entity that owns the health practitioner, including virus (Corona).

And the Minister of Health in the mainstream with his face to the directorates of health affairs in all regions of the Kingdom, the ministry emphasizes the paramount importance of reporting suspected syndrome Middle East respiratory (Corona) through the system adopted (fort); because the status quo is actively infectious diseases associated with, including Syndrome Middle East respiratory (Corona), requires all health practitioners to take maximum vigilance and readiness degrees.

Circular also stressed that the lack of communication or delay in reporting cases presents health practitioner violator to criminal responsibility and punishment prescribed in the system, and that link to jail for a period not exceeding six months and a fine of not more than 100 thousand riyals, or one of the two penalties, disciplinary sanctions the other, in addition to the consequent penalties of up to revocation of the license to practice the profession and write off the name of the licensed record.

 

While trying to hide cases may seem like absolute folly, it isn’t difficult to envision cases where the temptation may exist.

 

• Hospitals or clinics that report nosocomial infections are subject to additional scrutiny by the MOH, including a review of their infection control protocols, which if found wanting could result in fines or other punitive actions (in extreme cases, even closure – see Saudi MOH Closes Riyadh Dialysis Center Over MERS Concerns).
• Hospitals or clinics that admit to having MERS cases are likely to see a decrease in patient census, or difficulties keeping staff, over MERS concerns
• And wealthy or powerful patients may offer `incentives’ to practitioners to avoid the stigma of being labeled a `MERS’ case.

 

Just how big a problem this really is in Saudi Arabia is hard to say, but the MOH has been ratcheting up MERS reporting and infection control warnings to healthcare facilities since early last fall.

Saudi MOH: 1 MERS Case In Riyadh

 

# 9861