MERS-COV (20): QATAR, SAUDI ARABIA, WHO

Posted on 05TH APR 2017
tagged MERS-CoV, QATAR; 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] Qatar - WHO 4 Apr 2017
[2] Saudi Arabia - WHO 3 Apr 2017
[3] Saudi Arabia, 0 new cases - MOH 3-4 Apr 2017

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[1] Qatar - WHO 4 Apr 2017
Date: 4 Apr 2017
Source: WHO Emergencies, Preparedness, Response DON [edited]
http://www.who.int/csr/don/04-april-2017-mers-qatar/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Qatar 4 apr 2017
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On [21 Mar 2017], the national IHR focal point of Qatar reported one additional case of Middle East respiratory syndrome coronavirus (MERS-CoV).

Details of the case
A 62-year-old living in Doha city, Qatar developed symptoms on [15 Mar 2017]. The patient, who has comorbidities, was seen in a private clinic on [15 Mar 2017]. He was admitted to hospital on [20 Mar 2017] and was tested positive for MERS-CoV using real-time PCR (upE and ORF1b and N). He is currently in stable condition and admitted to a negative pressure isolation room on a ward.

The patient did not travel outside of Qatar in the last 7 months and has not reported a history of contact with camels or individuals with symptoms. An investigation of risk factors in the 14 days prior to the onset of symptoms is ongoing but has not identified the source of his infection.

To date, Qatar has reported 19 laboratory-confirmed cases of MERS. The last case was reported in June 2016 [http://www.who.int/csr/don/29-june-2016-mers-qatar/en/ and ProMED-mail post of 13 Jun 2016, MERS-CoV (61): Qatar, Saudi Arabia, RFI 20160613.4284624].

Globally, since September 2012, WHO has been notified of 1936 laboratory confirmed cases of infection with MERS-CoV, including at least 690 related deaths.

Public health response
The Department of Health Protection and Communicable Disease Control in the Ministry of Public Health has immediately carried out case investigation and contact tracing activities. All 23 contacts and health care workers were tested negative for MERS-CoV. All contacts will be followed up until the end of the 14-day monitoring period.

Health education messages about appropriate preventive measures were shared with all contacts, and they were advised to comply with the recommended MERS-CoV preventive measures and to report to health authorities on the development of any respiratory symptoms.

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 sources (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[According to this WHO update, the global tally of cases of MERS-CoV confirmed infected individuals reported to WHO is now 1936 including at least 690 related deaths, for a reported case fatality rate of at least 35.6 percent.

Further information about the most recent confirmed case in Qatar this year (2017) in the above update, which was not available at the time of the initial report (MERS-CoV (16): Qatar, Saudi Arabia (SH, MD, RI) 20170322.4918921), is that contact tracing did not reveal additional MERS-CoV infected individuals. So, the enigma persists in determining other possible high risk exposures to the MERS-CoV in Qatar.

The HealthMap/ProMED map of Qatar can be found at: http://healthmap.org/promed/p/130. - Mod.MPP]

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[2] Saudi Arabia - WHO 3 Apr 2017
Date: 3 Apr 2016
Source: WHO, Emergencies, Preparedness, Response DON [edited]
http://www.who.int/csr/don/03-april-2017-mers-saudi-arabia/en/

An outbreak of MERS occurred in a haemodialysis unit in a hospital in Riyadh. Contact tracing revealed that 8 symptomatic and 2 asymptomatic cases are associated with this outbreak.

Detailed information concerning the cases reported between [23 Feb and 16 Mar 2017] can be found in a separate document (see link below).

Globally, since September 2012, 1935 laboratory-confirmed cases of infection with MERS-CoV, including at least 690 related deaths, have been reported to WHO.

MERS-CoV cases reported between [23 Feb and 16 Mar 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 / 2017-03-16 / Bader / 63 / M / No / Yes / Yes / Yes / NA / 2017-03-12 / 2017-03-14 / 2017-03-15 / Alive / 2017-04-03
2 / 2017-03-13 / Wadi Aldwaser / 36 / M / Yes / NA / NA / NA / Yes†‡ / NA / NA / 2017-03-12 / Alive / 2017-04-03
3 / 2017-03-12 / Wadi Aldwaser / 32 / F / No / NA / NA / NA / Yes†‡ / 2017-03-09 / NA / 2017-03-11 / Alive / 2017-04-03
4 / 2017-03-11 / Qunfuthah / 79 / M / No / Yes / Yes / Yes / NA / 2017-03-03 / 2017-03-10 / 2017-03-11 / Deceased / 2017-03-14
5 / 2017-03-11 / Wadi Aldwaser / 39 / M / Yes / NA / NA / NA / Yes†‡ / NA / NA / 2017-03-11 / Alive / 2017-04-03
6 / 2017-03-10 / Wadi Aldwaser / 72 / M / No / Yes / NA / NA / NA‡ / 2017-03-05 / 2017-03-08 / 2017-03-09 / Alive / 2017-04-03
7 / 2017-03-10 / Wadi Aldwaser / 56 / F / No / Yes / NA / NA / Yes†‡ / NA / NA / 2017-03-09 / Alive / 2017-04-03
8 / 2017-03-10 / Wadi Aldwaser / 52 / F / No / Yes / NA / NA / Yes†‡ / 2017-03-08 / NA / 2017-03-09 / Alive / 2017-04-03
9 / 2017-03-10 / Wadi Aldwaser / 39 / F / No / NA / NA / NA / Yes†‡ / NA / NA / 2017-03-09 / Alive / 2017-04-03
10 / 2017-03-06 / Wadi Aldwaser / 48 / F / No / NA / NA / NA / NA‡ / 2017-03-03 / 2017-03-04 / 2017-03-05 / Alive / 2017-04-03
11 / 2017-03-05 / Wadi Aldwaser / 32 / F / No / NA / NA / NA / NA‡ / 2017-02-26 / 2017-03-03 / 2017-03-04 / Alive / 2017-04-03
12 / 2017-03-05 / Wadi Aldwaser / 31 / M / No / NA / NA / NA / NA‡ / 2017-02-28 / 2017-03-02 / 2017-03-04 / Alive / 2017-04-03
13 / 2017-03-03 / Uryirah / 47 / M / No / Yes / Yes / Yes / NA / 2017-02-28 / 2017-03-01 / 2017-03-02 / Alive / 2017-04-03
14 / 2017-02-28 / Alzulfi / 17 / F / No / No / NA / NA / NA / 2017-02-21 / 2017-02-26 / 2017-02-27 / Alive / 2017-04-03
15 / 2017-02-27 / Riyadh / 29 / M / No / No / Yes / Yes / NA / 2017-02-20 / 2017-02-25 / 2017-02-26 / Alive / 2017-04-03
16 / 2017-02-27 / Hail / 76 / M / No / NA / NA / NA / NA / 2017-02-19 / 2017-02-24 / 2017-02-26 / Alive / 2017-04-03
17 / 2017-02-27 / Bisha / 74 / M / No / Yes / Yes / Yes / NA / 2017-02-18 / 2017-02-25 / 2017-02-27 / Alive / 2017-04-03
18 / 2017-02-23 / Madinah / 76 / F / No / Yes / Yes / Yes / NA / 2017-02-14 / 2017-02-21 / 2017-02-23 / Deceased / 2017-03-14

†Case was detected through contact tracing of a previous MERS-CoV case.
‡Case is associated with the hospital associated outbreak as published in the Disease Outbreak News on [3 Apr 2017].

Public health response
In response to this outbreak, the rapid response team was dispatched from the Ministry of Health, and regional health directorate, and this was followed by the activation of the outbreak management team.

The following measures were implemented:
- Intensive infection control training was given to all the hospital staff including the strict monitoring of infection control measures in the dialysis unit.
- Active triage of all haemodialysis patients prior to initiation of dialysis was enforced. Those with symptoms were directed to designated areas and managed as suspected cases.
- The haemodialysis unit was cleaned using hospital grade disinfectants and hydrogen peroxide fumigation.
- Asymptomatic patients served by the unit (or their caregivers) were contacted daily by phone to ensure they do not attend another haemodialysis unit or seek healthcare services elsewhere without coordination.

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 sources (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[As mentioned below, case no.13 in the above update had not been previously reported as a newly confirmed case on the Saudi MOH website. It was reported as a recovery on the Saudi MOH website on 28 Mar 2017 (see prior ProMED post MERS-CoV (19): Saudi Arabia (SH, QS) 20170402.4942800 for details).

Of the 18 cases reported above, cases 1, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 17 have officially been reported as recoveries on the Saudi MOH MERS-CoV website (dates of recovery were 4 Apr, 3 Apr, 29 Mar, 20 Mar, 30 Mar, 28 Mar, 12 Mar, 4 Apr, 12 Mar, 30 Mar, 28 Mar and 14 Mar 2017 respectively), and case no 16 was reported as a fatality on 9 Mar 2017.

According to this update, all reported cases (10) in Wadi Aldawasir were associated with a nosocomial outbreak in a renal dialysis unit. In the original confirmation reports, the 1st 2 cases had been classified as primary cases with high risk exposures still under investigation, and one case had been classified as a secondary case in a household contact. Two questions that come to mind are whether the index case was ever identified and if so, what was the source of infection of the index case. And, remembering the initial reports on the early cases of MERS-CoV infection in 2012, mention was made of renal failure as a component of the illness, suggesting that the index cases in outbreaks associated with dialysis units may well have been individuals with acute renal failure related to MERS-CoV infection treated in dialysis units affiliated with hospitals where they are being treated (this is not the 1st outbreak of MERS-CoV associated with a renal dialysis unit).

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

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[3] Saudi Arabia, 0 new cases - MOH 3-4 Apr 2017
Date: 4 Apr 2017
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of 14:00 [2:00 PM] today [Tue 4 Apr 2017], there have been a total of:
1583 laboratory-confirmed cases of MERS-CoV infection, including
656 deaths [reported case fatality rate 41.4 per cent],
915 recoveries, and
12 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. There was an additional case not previously reported on the MOH website from 3 Mar 2017 which was included in the above WHO update (case no. 13) in section [2] above that has been added to the total number of cases. - Mod.MPP]

Since the last ProMED-mail update [Mon 27 Mar 2017], there have been a total of:
0 newly confirmed cases, [note that there was delayed reporting of case 13 from WHO update in [2] above]
0 newly reported fatalities, and
2 newly reported recoveries.

Information on newly reported recoveries (3 recoveries)
Date: 4 Apr 2017 (2 recoveries)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-04-0...

1- A 48-year-old Saudi female, non-healthcare worker from Wadi Aldwasir [Riyadh region] with a history of pre-existing co-morbidities [reported as a newly confirmed case on 6 Mar 2017 at which time she was noted to be in critical condition. Classified as a secondary healthcare acquired case in a patient (see case no. 10 in WHO update [2] above). - Mod.MPP].

2- A 63-year-old Saudi male, non-healthcare worker from Badr [Al Madinah region] with a history of pre-existing co-morbidities [reported as a newly confirmed case on 16 Mar 2017 at which time he was noted to be in stable condition. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness (see case no. 1 in WHO update [2] above.) - Mod.MPP].

Date: 3 Apr 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-03-0...

3- A 32-year-old Saudi female, non-healthcare worker from Wadi Aldwasir [Riyadh region] with a history of pre-existing co-morbidities [reported as newly confirmed case on 12 Mar 2017 at which time she was noted to be in asymptomatic. Classified as a secondary case in a household contact. (see case no. 3 in WHO update [2] above. Note that she apparently had mild symptoms with onset on 9 Mar 2017 but was not hospitalized according to the WHO update information). - Mod.MPP].

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Communicated by:
ProMED-mail

[While there have been no newly confirmed cases of MERS-CoV infection identified in Saudi Arabia during the past 2 days since the last update, the WHO Saudi Arabia update identified a newly confirmed case not previously listed on the Saudi MOH MERS-CoV website.

Maps showing the locations of the newly reported recoveries can be found at the source URLs. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/131.]

See Also

MERS-CoV (19): Saudi Arabia (SH, QS) 20170402.4942800
MERS-CoV (18): Africa, animal reservoir, camels, 2015, research 20170331.4939980
MERS-CoV (17): Saudi Arabia (RI) 20170327.4929414
MERS-CoV (16): Qatar, Saudi Arabia (SH, MD, RI) 20170322.4918921
MERS-CoV (15): Saudi Arabia (RI, MK) nosocomial outbreak, WHO, RFI 20170312.4894950
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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