Posted on 28TH JAN 2017
tagged MERS-CoV, Saudi Arabia

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Saudi Arabia, 2 new cases - MOH 26-27 Jan 2017
[2] Saudi Arabia - WHO 26 Jan 2017 (covers 1-13 Jan 2017)

[1] Saudi Arabia, 2 new cases - MOH 26-27 Jan 2017
Date: Fri 27 Jan 2017
Source: Saudi MoH 26-27 Jan 2017 [edited]

As of 14:00 [2:00 pm] today [Fri 27 Jan 2017], there have been a total of:
1544 laboratory-confirmed cases of MERS-CoV infection, including 641 deaths [reported case fatality rate 41.5 percent], 894 recoveries, and 9 currently active cases.

Since the last ProMED-mail update [Wed 25 Jan 2017], there have been a total of:
2 newly confirmed cases, 0 newly reported fatality, and 0 newly reported recoveries.

Information on newly reported cases (2 cases)
Date: Fri 27 Jan 2017 (1 case)

1- A 59-year-old Saudi male, non-healthcare worker from Turaba [Makkah region], currently in critical condition. Classified as a primary case with history of direct contact with camels in the 14 days preceding onset of illness.

Date: Thu 26 Jan 2017 (1 case)

2- A 30-year-old Saudi male, healthcare worker from Jeddah [Makkah region], currently in stable condition. Classified as a secondary healthcare acquired case in a healthcare worker.

Communicated by:

[In the 2 days since the last ProMED-mail update on MERS-CoV in KSA, there have been 2 newly confirmed cases reported. Both from Makkah region (one from Jeddah and one from Turaba). This now brings the total number of MERS-CoV cases reported by Saudi Arabia since [Sun1 Jan 2017] to 22, and represents the 7th consecutive day with a new case being reported each day. Notable is the case reported today [Fri 27 Jan 2017] in a healthcare worker in Jeddah. Hopefully this will be a single case in a healthcare worker with a lapse in infection control procedures and is not the debut of a nosocomial outbreak.

Returning to the 22 cases reported since the beginning of the year, the geographic breakdown includes 6 cases from Al Qaṣīm region (all 6 from Buraidah), 5 cases from Riyadh region (4 from Riyadh and one from Al Qararah), 5 cases from Makkah region (3 from Jeddah, 1 from Taif and 1 from Turaba), 4 cases from Ash Sharqīyah (Eastern) region (3 from Hufoof and 1 from Jubail), and 1 each from Al Madinah and Najran regions.

Five of the 6 cases from Buraidah (Al Qasim region) were definitively confirmed to be part of a nosocomial outbreak involving 2 healthcare centers (see discussion in WHO update below).

Maps of the locations of the newly confirmed cases can be found at the source URL. The HealthMap/ProMED map of Saudi Arabia can be found at - Mod.MPP]

[2] Saudi Arabia - WHO 26 Jan 2017 (covers 2-7 Jan 2017)
Date: Thu 26 Jan 2017
Source: WHO Emergency, Preparedness, Response - DON 26 Jan 2017 [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia 26 Jan 2017
Between [Mon 2 and Sun 7 Jan 2017] the National IHR Focal Point of Saudi Arabia reported nine (9) additional cases of Middle East Respiratory Syndrome (MERS) including two (2) fatal cases. Two (2) deaths among previously reported MERS cases (cases no. 7 and 8 in DON published on [Tue17 Jan 2017]) were also reported.

Detailed information concerning these cases can be found in a separate document [see link to MERS-CoV cases reported between [Mon 2 and Sun 7 Jan 2017], an excel spreadsheet available for download at source URL]. The 5 cases from Buridah reported are part of a small health care setting outbreak involving 2 hospitals. A Ministry of Health rapid response team has been dispatched and measures to prevent further cases including contact tracing, and strengthening of infection, prevention and control have been put in place. None of the cases reported are health care workers.

(Chart from WHO data)
Case no. Date report WHO/ City of residence/ Age /Sex / HCW/ Comorbidities/ Camel Exposure / Camel milk / Exposure other cases/ Date of onset symptoms/ Date of hospitalization / Date of lab confirm / Status / Date of outcome

1 2017-01-07 Hofouf 57 M No No NA NA NA 2016-12-26 2017-01-05 2017-01-06 Alive
2 2017-01-06 Buridah 73 F No Yes NA NA NA 2017-01-03 2016-12-24** 2017-01-05 Alive
3 2017-01-05 Buridah 70 F No Yes NA NA NA 2016-12-23 2017-01-03 2017-01-05 Alive
4 2017-01-04 Buridah 88 F No Yes NA NA NA 2016-12-19 2017-01-01 2017-01-03 Deceased 2017-01-03
5 2017-01-04 Buridah 87 F No Yes NA NA NA 2016-12-29 2017-01-02 2017-01-04 Alive
6 2017-01-04 Riyadh 56 M No Yes NA NA NA 2016-12-28 2017-01-02 2017-01-04 Alive
7 2017-01-04 Riyadh 59 M No NA No No Yes NA NA 2017-01-02 Alive
8 2017-01-02 Madinah 70 M No Yes Yes Yes NA 2016-12-25 2017-01-01 2017-01-02 Alive
9 2017-01-02 Buridah 63 F No Yes NA NA NA 2016-12-29 2016-12-31 2017-01-01 Deceased 2017-01-02

Globally, since September 2012, 1888 laboratory-confirmed cases of infection with MERS-CoV including at least 670 related deaths have been reported to WHO.

WHO risk assessment
MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed 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.

Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[The WHO report confirms the existence of a small, limited nosocomial outbreak in Buraidah (Al Qasim region) in the beginning of this month [January 2017] involving 5 cases. In the original reports from the Saudi MOH, only 2 of the 5 cases were identified as having had contact in the healthcare environment (case No. 2 above, and another case reported on [Tue 10 Jan 2017] not included in the above outbreak).

As I've said before, it is safe to say that MERS-CoV is endemic in Saudi Arabia with cases occurring associated with contact with camels, and the occasional healthcare associated transmission, now hopefully limited and small numbers. What remains to be defined are the high risk exposures that have resulted in "primary" cases where there is no clear history of exposure to camels, nor is there a clear history of contact with other known MERS-CoV infected individuals. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at:]

See Also
MERS-CoV (08): Saudi Arabia (MK, RI) 20170125.4792072
MERS-CoV (06): Saudi Arabia, WHO 20170119.4775249
MERS-CoV (05): Saudi Arabia (NJ, SH, RI), RFI 20170114.4766221
MERS-CoV (04): Saudi Arabia (MK, QS), nosocomial outbreak, RFI 20170110.4754928
MERS-CoV (03): Saudi Arabia (SH) & clarification 20170108.4750515
MERS-CoV (02): Saudi Arabia (QS) nosocomial transmission 20170107.4748974
MERS-CoV (01): Saudi Arabia (QS,RI,MD), RFI 20170105.4744802
MERS-CoV (123): Saudi Arabia (MK, AS) new cases 20161231.4734758
MERS-CoV (122): Saudi Arabia 20161228.4728747
MERS-CoV (121): Saudi Arabia, new cases 20161223.4720359
MERS-CoV (120): Saudi Arabia, new cases, WHO 20161219.4709903
MERS-CoV (110): Saudi Arabia (NJ,MK) new cases 20161108.4614294
MERS-CoV (100): Saudi Arabia (JF) new case, WHO 20160922.4508259
MERS-CoV (90): Saudi Arabia (RI), camel association, UAE 20160808.4402381
MERS-CoV (80): Saudi Arabia (MK), WHO 20160707.4331372
MERS-CoV (70): Saudi Arabia (MK), UAE, WHO, RFI 20160621.4300452
MERS-CoV (60): Saudi Arabia (TB) 20160610.4276126
MERS-CoV (50): Saudi Arabia (RI, NJ) 20160406.4143365
MERS-CoV (40): Egypt, animal reservoir, camel, ex Sudan, susp. 20160316.4097730
MERS-CoV (30): Saudi Arabia (QS) WHO 20160303.4066494
MERS-CoV (20): Saudi Arabia (NJ, RI) 20160212.4016509
MERS-CoV (10): Saudi Arabia (MK), Thailand ex Oman, RFI 20160125.3964309
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188
MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383
MERS-CoV (69): Saudi Arabia, new case, RFI 20141230.306305
MERS-CoV (01): Bangladesh, KSA, Algeria, UAE, Iran, WHO, RFI 20140616.2541707
MERS-CoV - Eastern Mediterranean (82): anim res, camel, seroepidemiology 20140613.2537848
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean: Saudi Arabia, new case, RFI 20130518.1721601
Novel coronavirus - Eastern Mediterranean (29): MERS-CoV, ICTV nomenclature 20130516.1717833
Novel coronavirus - Eastern Mediterranean: bat reservoir 20130122.1508656
Novel coronavirus - Eastern Mediterranean (06): comments 20121225.1468821
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733