MERS-COV (24): UNITED ARAB EMIRATES (ABU DHABI), SAUDI ARABIA (RIYADH), WHO

Posted on 25TH APR 2017
tagged MERS-CoV, United Arab Emirates; 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] UAE, 2 new cases - WHO 24 Apr 2017
[2] Saudi Arabia, 4 new cases, 2 fatalities - 16-25 Apr 2017

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[1] UAE, 2 new cases - WHO 24 Apr 2017
Date: Mon 24 Apr 2017
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]
http://www.who.int/csr/don/24-april-2017-mers-uae/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - United Arab Emirates 24 Apr 2017
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Between [9 and 11 Apr 2017], the National IHR Focal Point of United Arab Emirates (UAE) reported 2 additional cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Details of the cases
The 2 cases identified in Abu Dhabi, UAE, were roommates. The case reported to WHO on 9 Apr 2017 (31-year-old) passed away on 16 Apr 2017 and the 2nd case reported to WHO on 11 Apr 2017, identified through tracing of household contacts, is asymptomatic and has been admitted to a negative pressure isolation room on a ward in hospital. The source of infection of the 31-year-old MERS case is under investigation. Contact tracing of household and healthcare contacts is ongoing. Detailed information concerning the cases can be found in a separate document (see link below).

[Information on the 2 cases taken from WHO document: MERS-CoV cases reported between 9 and 11 Apr 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 / 11 Apr 2017 / United Arab Emirates / Abu Dhabi / 43 / M / No / No / No / No / Yes* / NA / NA / 11 Apr 2017 / Alive / 2017-04-24
2 / 9 Apr 2017 / United Arab Emirates / Abu Dhabi / 31 / M / No / No / NA / NA / NA / 24 Mar 2017 / 3 Apr 2017 / 6 Apr 2017 / Deceased / 16 Apr 2017
*Case was detected through contact tracing of a previous MERS-CoV case.

To date, United Arab Emirates has reported 81 laboratory confirmed cases of MERS. The last case was reported in June 2016 (see Disease Outbreak News published on 21 June 2016).

Globally, since September 2012, 1938 laboratory-confirmed cases of infection with MERS-CoV including at least 691 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.

WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, these people should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[One presumes that the index case in this report, the 31 year old male, was the case reported in MERS-CoV (22): UAE (AZ), Saudi Arabia (RI,MK) Qatar, RFI 20170415.4971825 and the 2nd case reported, the 43 year old male was identified through contact tracing.

According to this WHO update, there have now been a total of 1938 laboratory-confirmed cases of infection with MERS-CoV including at least 691 related deaths reported to WHO since the MERS-CoV was identified in September 2012, bringing the reported case fatality rate to 35.7 percent.

The HealthMap/ProMED map of the United Arab Emirates can be found at: http://healthmap.org/promed/p/132. - Mod.MPP]

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[2] Saudi Arabia, 4 new cases, 2 fatalities - 16-25 Apr 2017
Date: Tue 25 Apr 2017
Source: Saudi MOH 16-25 Apr 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of 14:00 [2:00 PM] today [Tue 25 Apr 2017], there have been a total of:
1592 laboratory-confirmed cases of MERS-CoV infection, including
652 deaths [reported case fatality rate 41.3 per cent],
926 recoveries, and
8 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 [Sat 15 Apr 2017], there have been a total of:
4 newly confirmed cases, [3 of whom are reported to be asymptomatic]
2 newly reported fatalities, and
4 newly reported recoveries

Information on newly confirmed cases (4 cases)
Date: 21 Apr 2017 (3 asymptomatic cases)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-21-0...?

1- A 50 year old expat male, non-healthcare worker from Wadi Aldawasir [Riyadh region] currently in stable condition listed as an asymptomatic case. Classified as a secondary case in a household contact.

2- A 58 year old expat male, non-healthcare worker from Wadi Aldawasir [Riyadh region] currently in stable condition listed as an asymptomatic case. Classified as a secondary case in a household contact.

3- A 30 year old expat male, healthcare worker from Wadi Aldawasir [Riyadh region] currently in stable condition listed as an asymptomatic case. Classified as a secondary healthcare acquired case in a healthcare worker.

Date: 19 Apr 2017 (1 case)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-19-0...?

4- An 86 year old Saudi male, non-healthcare worker from Riyadh [Riyadh region], currently in stable condition. Classified as a primary case with high risk exposure history still under investigation.

Information on newly reported fatalities (2 fatalities)
Date: 21 Apr 2017 (1 case)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-21-0...?

1- A 60 year old expat male, non-healthcare worker from Alhawia [Makkah region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 11 Apr 2017 at which time he was noted to be in critical condition. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness. - Mod.MPP]

Date: 19 Apr 2017 (1 case)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-19-0...?

2- A 55 year old expat male, non-healthcare worker from Wadi Aldwasir [Riyadh region] with pre-existing co-morbidities. [I was unable to find any prior report compatible with this individual. Hopefully more detailed information will be available in the next WHO update. - Mod.MPP]

Information on newly reported recoveries (4 recoveries)
Date: 24 Apr 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-24-0...?

1 - A 61 year old Saudi female, non-healthcare worker from Turaba [Makkah region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 14 Apr 2017 at which time she was noted to be in stable condition. Classified as a primary case with possible high risk exposure history in the 14 days preceding onset of illness still under investigation. - Mod.MPP]

Date: 23 Apr 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2017-04-23-0...?

2 - A 72 year old Saudi male, non-healthcare worker from Riyadh [Riyadh region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 11 Apr 2017 at which time he was noted to be in stable condition. Classified as a primary case with possible high risk exposure history in the 14 days preceding onset of illness still under investigation. - Mod.MPP]

Date: 16 Apr 2017 (2 recoveries)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-04-16-0...

3- A 29 year old Saudi male, non-healthcare worker from Riyadh [Riyadh region] 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 a history of direct exposure to camels in the 14 days preceding onset of illness. - Mod.MPP]

4- A 54 year old Saudi male, non-healthcare worker from Alkharj [Riyadh region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 27 Mar 2017 at which time he was noted to be in stable condition. Classified as a primary case with a history of direct exposure to camels in the 14 days preceding onset of illness. - Mod.MPP]

--
Communicated by:
ProMED-mail

[In today's update, while there are a total of 6 newly confirmed cases of MERS-CoV infection reported above (2 from the UAE and 4 from Saudi Arabia), 4 of this 6 cases are reported to be asymptomatic individuals who were identified through contact tracing - 3 are household contacts of infected individuals and 1 is a healthcare worker presumably having cared for 1 of the cases. Noteworthy is the report of 3 additional infections related to the outbreak identified in Wadi Alwadasir, Riyadh region associated with a hemodialysis facility.

As the contact tracing efforts have been yielding asymptomatic infections (Saudi Arabia has reported at least 91 asymptomatic infections since reporting began in 2012), I have not been able to find information on whether any of the infected individuals identified as asymptomatic infections early on have progressed to clinical disease. According to the best information available, 41 of the 44 previously reported asymptomatic infected individuals reported since January 2016 have all been reported as recoveries (the 3 newly reported asymptomatic infections reported in this currently update are still pending outcome information).

Maps of Saudi Arabia showing the locations of the newly reported cases, fatalities and recoveries reported in Saudi Arabia can be found at the source URL. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/5767.]

See Also
MERS-CoV (23): Saudi Arabia (AS) animal reservoir, human contact, OIE, RFI 20170421.4986081
MERS-CoV (22): UAE (AZ), Saudi Arabia (RI,MK) Qatar, RFI 20170415.4971825
MERS-CoV (21): Egypt, animal reservoir, camel, ex Sudan, control, RFI 20170405.4948727
MERS-CoV (20): Qatar, Saudi Arabia, WHO 20170404.4947466
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 (70): Saudi Arabia (MK), UAE, WHO, RFI 20160621.4300452
MERS-CoV (12): UAE, Oman, Saudi Arabia, WHO 20160126.3967808
MERS-CoV (06): UAE (AZ) 20160114.3937314
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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