MERS-COV (15): SAUDI ARABIA (RIYADH, MAKKAH) NOSOCOMIAL OUTBREAK, WHO, REQUEST FOR INFORMATION

Posted on 12TH MAR 2017
tagged MERS-CoV, Saudi Arabia

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Saudi Arabia, 6 new cases, nosocomial outbreak - Saudi MOH 7-11 Mar 2017
[2] Saudi Arabia - WHO update 10 Mar 2017 for period 6-21 Feb 2017

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[1] Saudi Arabia, 6 new cases, nosocomial outbreak - Saudi MOH 7-11 Mar 2017
Date: Sat 11 Mar 2017 10:20 AM
Source: Saudi MOH 7-11 Mar 2017 [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx

As of 14:00 [2:00 PM] today [Sat 11 Mar 2017], there have been a total of:
1573 laboratory-confirmed cases of MERS-CoV infection, including
650 deaths [reported case fatality rate 41.3 per cent],
902 recoveries, and
21 currently active cases.

[As previously mentioned, the numbers of deaths, recoveries and currently active cases come from my spreadsheet tallies and differ from those listed on the Saudi MOH website. - Mod.MPP]

Since the last ProMED-mail update [Mon 6 Mar 2017], there have been a total of:
6 newly confirmed cases,
1 newly reported fatality, and
2 newly reported recoveries.

Information on newly reported cases (6 cases)
Date: 11 Mar 2017 (2 cases)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-03-11-0...

1 - a 39 year old expat male, non-healthcare worker from Wadi Aldawasir [Riyadh region], noted to be asymptomatic at time of confirmation report. Classified as a secondary healthcare acquired case in a healthcare worker.

2 - a 79 year old Saudi male, non-healthcare worker from Al Qunfudhah [Makkah region], currently in a stable condition. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness.

Date: 10 Mar 2017 (4 cases)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-03-10-0...

3 - a 39 year old Saudi female, non-healthcare worker from Wadi Aldawasir [Riyadh region], currently in a stable condition. Classified as a secondary healthcare acquired case in a patient.

4 - a 52 year old Saudi female, non-healthcare worker from Wadi Aldawasir [Riyadh region], currently in a stable condition. Classified as a secondary case in a household contact.

5 - a 56 year old Saudi female, non-healthcare worker from Wadi Aldawasir [Riyadh region], noted to be in a stable condition. Classified as a secondary healthcare acquired case in a patient.

6 - a 72 year old Saudi male, non-healthcare worker from Wadi Aldawasire [Riyadh region], noted to be in a critical condition. Classified as a secondary healthcare acquired case in a patient.

Information on newly reported fatalities (1 fatality)
Date: 9 Mar 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-03-09-0...

- a 76 year old Saudi male, non-healthcare worker, from Hail with a history of pre-existing co-morbidities [reported as a newly confirmed case on 27 Feb 2017, at which time he was noted to be in critical condition. Classified as a primary case with high risk exposure history in the 14 days preceding onset of illness still under investigation. - Mod.MPP].

[According to the WHO report below, there was an additional fatality that occurred on 21 Feb 2017 (see case no. 9 below). - Mod.MPP]

Information on newly reported recoveries (2 recoveries)
Date: 8 Mar 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-03-08-0...

1 - a 49 year old Saudi male, non-healthcare worker from Riyadh with no history of co-morbidities. [Reported as a newly confirmed case on 20 Feb 2017 at which time he was noted to be in a critical condition. Classified as a primary case with high risk exposure history in the 14 days preceding onset of illness still under investigation. - Mod.MPP]

Date: 7 Mar 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-03-07-0...

2 - a 61 year old Saudi male, non-healthcare worker from Jeddah [Makkah region] with a history of pre-existing co-morbidities. [Reported as a newly confirmed case on 20 Feb 2017 at which time he was noted to be in a stable condition. Classified as a primary case with high risk exposure history in the 14 days preceding illness still under investigation. - Mod.MPP]

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[Unfortunately, the Saudi MOH MERS-CoV website has been unavailable intermittently.

As speculated in the previous update, it appeared as though there was a nosocomial outbreak in Wadi Aldawasir with 3 cases having been identified, one confirmed as nosocomial acquisition, the other 2 as primary cases with high risk exposures still under investigation. This is no longer speculation, as an additional 5 cases have been confirmed in the past 48 hours, 4 listed as healthcare acquired (3 in patients, 1 in a healthcare worker who was asymptomatic at the time of confirmation), and 1 in a household contact. Hence, the number of cases in this outbreak in Wadi Aldawasir is now 8. It would be of interest to know whether the "index case" in this nosocomial outbreak has been identified through record reviews of inpatients not diagnosed as MERS-CoV infected but with clinically compatible illness in the identified healthcare facility.

Wadi Wadi Al Dawasir is a town in Najd, located in the Dawasir valley in the Riyadh region. It is about 742 km (461 miles) from Riyadh by road, and 364 km (226 miles) by road from Bisha, both locations with identified MERS-CoV infected individuals in the week preceding the identification of the 1st reported MERS-CoV infected individual in Wadi Al Dawasir on 5 Mar 2017.

Maps of Saudi Arabia showing the locations of all cases reported above (including fatality and recoveries) can be found at the source URL. - Mod.MPP]

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[2] Saudi Arabia - WHO update 10 Mar 2017 for period 6-21 Feb 2017
Date: 10 Mar 2017
Source: WHO Emergencies, Preparedness, Response 10 Mar 2017 [edited]
http://www.who.int/csr/don/10-march-2017-mers-saudi-arabia/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia [10 Mar 2017]
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Between [6 and 21 Feb 2017] the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported 12 additional cases of Middle East respiratory syndrome (MERS) including 3 fatal cases. Four deaths among previously reported MERS cases were also reported (case numbers 1, 2, 4 and 6 in the Disease Outbreak News published on 10 Feb 2017).

Detailed information concerning these cases can be found in a separate document (see link below). Most of these cases are primary cases with exposure to infected dromedary camels or consumption or their raw milk, which is the most likely source of their infection.

MERS-CoV cases reported between 6-21 Feb 2017

Case no. / Date report WHO / City of residence / Age / Sex / HCW / Co-morbidities / Camel exposure / Camel milk / Exposure to other cases / Date of onset of symptoms / Date of hospitalization / Date of lab confirmation / Status / Date of outcome

1 / 2017-02-21 / Mahayl / 63 / M / No / Yes / Yes / Yes / NA / 2017-02-14 / 2017-02-18 / 2017-02-20 / Alive / 2017-03-10
2 / 2017-02-20 / Jeddah / 61 / M / No / Yes / Yes / Yes / NA / 2017-02-09 / 2017-02-18 / 2017-02-20 / Alive / 2017-03-10
3 / 2017-02-20 / Riaydh / 49 / M / No / No / NA / NA / NA / 2017-02-09 / 2017-02-18 / 2017-02-20 / Alive / 2017-03-10
4 / 2017-02-19 / Riyadh / 67 / M / No / Yes / Yes / Yes / NA / 2017-02-12 / 2017-02-16 / 2017-02-18 / Alive / 2017-03-10
5 / 2017-02-19 / Jeddah / 54 / M / No / Yes / Yes / Yes / NA / 2017-02-08 / 2017-02-11 / 2017-02-18 / Alive / 2017-03-10
6 / 2017-02-17 / Jeddah / 75/ M / No / Yes / Yes / Yes / NA / 2017-02-12 / 2017-02-15 / 2017-02-16 / Deceased / 2017-02-19
7 / 2017-02-13 / Almkhwah / 71 / M / No / Yes / Yes / Yes / NA / 2017-02-04 / 2017-02-12 / 2017-02-13 / Alive / 2017-03-10
8 / 2017-02-13 / Khyber / 53 / M / No / Yes / NA / NA / NA / 2017-02-09 / 2017-02-10 / 2017-02-12 / Alive / 2017-03-10
9 / 2017-02-11 / Alasyah / 80 / M / No / Yes / Yes / Yes / NA / 2017-02-03 / 2017-02-08 / 2017-02-10 / Deceased / 2017-02-21
10 / 2017-02-09 / Makkah / 60 / M / No / Yes / Yes / Yes / NA / 2017-02-03 / 2017-02-06 / 2017-02-08 / Deceased / 2017-02-10
11 / 2017-02-08 / Bukiriah / 54 / M / No / Yes / Yes / Yes / NA / 2017-02-03 / 2017-02-06 / 2017-02-07 / Alive / 2017-03-10
12 / 2017-02-06 / Madinah / 45 / M / No / Yes / NA / NA / NA / 2017-02-01 / 2017-02-04 / 2017-02-05 / Alive / 2017-03-10

Globally, since September 2012, 1917 laboratory-confirmed cases of infection with MERS-CoV including at least 684 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.

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[As mentioned above, 1917 laboratory confirmed infections with MERS-CoV including 684 deaths have been reported to WHO since September 2012.

The above WHO report contains additional information that was not previously available on the MOH MERS-CoV website: case no. 11 was reported as a recovery on 21 Feb 2017, but no report of the initial confirmation was available on the MOH website for 8 Feb 2017; case 2 was initially reported as a primary case with high risk exposures still under investigation. According to the above report, there was a history of contact with camels preceding onset of illness.

For the period covered by this update, all cases had been reported as primary cases, with 9 of the 12 cases reporting a history of direct contact with camels in the 14 days preceding onset of their illness and the other 3 cases still under investigation for possible high risk exposures.

The HealthMap/ProMED map of Saudi Arabia can be found at http://healthmap.org/promed/p/131. - Mod.MPP]

See Also
MERS-CoV (14): Saudi Arabia 20170306.4875743
MERS-CoV (13): Saudi Arabia (MK, RI) 20170219.4850389
MERS-CoV (12): Saudi Arabia (BA, MD, QS) 20170213.4836328
MERS-CoV (11): Saudi Arabia (NJ, MD, MK), WHO 20170211.4832839
MERS-CoV (10): Saudi Arabia (SH, MK) 20170202.4811346
MERS-CoV (09): Saudi Arabia (MK) WHO 20170127.4797694
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
2016
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MERS-CoV (123): Saudi Arabia (MK, AS) new cases 20161231.4734758
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188
2015
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MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383
2014
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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
2013
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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
2012
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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
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