MERS-COV (40): SAUDI ARABIA (RIYADH) WHO

Posted on 03RD OCT 2018
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 (Riyadh), 1 new case - Saudi MOH
[2] Saudi Arabia - WHO update 3 Oct 2018 (1 Jun 2018 - 16 Sep 2018)

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[1] Saudi Arabia (Riyadh), 1 new case - Saudi MOH
Date: 3 Oct 2018
Source: Saudi MOH 30 Sep 2018 - 3 Oct 2018 [edited]
https://www.moh.gov.sa/en/CCC/events/national/Pages/2018.aspx

Date of report: 3 Oct 2018
Case No. 18 - 1756
MERS in Afeef city: 22 year old male in Afeef city, Riyadh region
Contact with camels: no
Case classification: secondary, household contact
Current status: home-isolated

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communicated by:
ProMED-mail

[This is the 1st MERS-CoV laboratory confirmed infection reported since the last ProMED-mail update on 29 Sep 2018. One suspects that this individual either had a mild infection or was asymptomatic and detected during testing of known contacts of active cases. As there was only one prior case (Case No. 18- 1753) reported from Afeef in the 2 weeks prior to this confirmation, I suspect this individual was a household contact of this 50 year old male reported as a confirmed case on 24 Sep 2018, and as a fatality on 29 Sep 2018.

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

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[2] Saudi Arabia - WHO update 3 Oct 2018 (1 Jun 2018 - 16 Sep 2018)
Date: 3 Oct 2018
Source: WHO Emergencies, preparedness, response, Disease Outbreak News [edited]
http://www.who.int/csr/don/03-october-2018-mers-saudi-arabia/en/

From [1 Jun 2018] through [16 Sep 2018], the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported 32 additional cases of Middle East respiratory syndrome (MERS), including 10 deaths.

Among these 32 cases, 12 cases were part of 5 distinct clusters (one health care and 4 household clusters). The details of these clusters are described below, and detailed information concerning the cases reported can be found in a separate document (see link below).

- Cluster 1: From [1 through 8 Jun 2018], 4 additional cases in a previously reported household cluster were reported in Najran, Saudi Arabia. The initial case reported in this cluster was reported on 30 May [2018] (aged 52 years old). One of the secondary cases was a health care worker.

- Cluster 2: From [9 through 14 Jul 2018], a household cluster of 2 cases was reported from Afif city, Riyadh region. No health care workers were infected.

- Cluster 3: From [3 through 4 Sep 2018], a health care facility in Buraidah City, Al-Quassim Region reported a cluster of 2 patients. No other patients or health care workers were infected.

- Cluster 4: From [1 through 16 Sep 2018], a household cluster of 2 cases, including the suspected index case with reported dromedary exposure was reported from Buraidah City, Al-Quassim Region. No health care workers were infected.

- Cluster 5: From [10 through 16 Sep 2018], a household cluster of 2 cases, including the suspected index case with reported dromedary exposure were reported from Riyadh City, Riyadh Region. No health care workers were infected.

MERS-CoV cases reported between [1 Jun 2018 and 16 Sep 2018]
Notification Date: Age / Gender / National / Healthcare Worker / Region / City / Onset Date / Admission Date / Co-morbidity / Dromedary Exposure / Symptomatic / Outcome / Date of Death
- Cluster 1
1-Jun-18: 49 / M / Yes / No / Najran / Najran / 28-May-18 / 30-May-18 / No / UI / Yes / Survived
2-Jun-18: 50 / M / Yes / No / Najran / Najran / 29-May-18 / 30-May-18 / Yes / UI / Yes / Survived
2-Jun-18: 33 / M / Yes / No / Najran / Najran / 29-May-18 / 30-May-18 / No / UI / Yes / Survived
8-Jun-18: 40 / M / No / Yes / Najran / Najran / 27-May-18 / 27-May-18 / Yes / No / Yes / Survived
- Cluster 2
9-Jul-18: 35 / M / Yes / No / Riyadh / Afif / 2-Jul-18 / 7-Jul-18 / No / Yes / Yes . Died / 12-Aug-18
14-Jul-18: 45 / M / Yes / No / Riyadh / Afif / 12-Jul-18 / 13-Jul-18 / No / UI / Yes / Survived
- Cluster 3
1-Sep-18: 61 / M / Yes / No / Al-Qassim / Buraidah / 26-Aug-18 / 29-Aug-18 / Yes / Yes / Yes / Died / 1-Sep-18
16-Sep-18: 62 / M / Yes / No / Al-Qassim / Buraidah / 13-Sep-18 / 14-Sep-18 / Yes / No / Yes / Survived
- Cluster 4
10-Sep-18: 44 / M / Yes / No / Riyadh / Riyadh / 1-Sep-18 / 9-Sep-18 / Yes / Yes / Yes / Survived
16-Sep-18: 34 / M / Yes / No / Riyadh / Riyadh / 14-Sep-18 / 15-Sep-18 / No / No / Yes / Survived
- Cluster 5
3-Sep-18: 66 / M / Yes / No / Al-Qassim / Buraidah / 26-Aug-18 / 31-Aug-18 / Yes / No / Yes / Died / 5-Sep-18
4-Sep-18: 52 / M / Yes / No / Al-Qassim / Buraidah / 31-Aug-18 / 1-Sep-18 / Yes / No / Yes / Died / 5-Sep-18

- Cases not associated with clusters
3-Jun-18; 76 / M / Yes / No / Najran / Najran / 28-May-18 / 1-Jun-18 / Yes / Yes / Yes / Survived
9-Jun-18: 57 / M / No / No / Jeddah / Jeddah / 2-Jun-18 / 7-Jun-18 / Yes / Yes / Yes / Died / 9-Jun-18
11-Jun-18: 64 / M / Yes / No / Riyadh / Riyadh / 2-Jun-18 / 8-Jun-18 / Yes / No / Yes / Survived
14-Jun-18: 54 / F / No / No / Najran / Najran / 8-Jun-18 / 11-Jun-18 / No / No / Yes / Survived
19-Jun-18: 84 / M / Yes / No / Riyadh / Riyadh / 14 -Jun-18 / 17-Jun-18 / Yes / Yes / Yes / Survived
30-Jun-18: 70 / M / Yes / No / Riyadh / Muzahmia / 27-Jun-18 / 29-Jun-18 / Yes / Yes / Yes / Died / 14-Jul-18
7-Jul-18: 55 / M / Yes / No / Northern / Arar / 22-Jun-18 / 29-Jun-18 / Yes / No / Yes / Survived
10-Jul-18: 74 / M / Yes / No / Riyadh / Riyadh / 6-Jul-18 / 9-Jul-18 / Yes / Yes / Yes / Died / 7-Aug-18
13-Jul-18: 29 / M / Yes / No / Najran / Najran / 6-Jul-18 / 10-Jul-18 / No / UI / Yes / Survived
20-Jul-18: 68 / M / Yes / No / Northern / Arar / 13-Jul-18 / 19-Jul-18 / Yes / No / Yes / Died / 20-Jul-18
25-Jul-18: 73 / M / Yes / No / Al-Qassim / Alsaih / 11-Jul-18 / 23-Jul-18 / Yes / Yes / Yes / Survived
1-Aug-18: 55 / M / Yes / No / Al-Ahsaa / Hofouf / 26-Jul-18 / 30-Jul-18 / Yes / Yes / Yes / Survived
4-Aug-18: 82 / F / Yes / No / Tabouk / Tabouk / 24-Jul-18 / 2-Aug-18 / Yes / No / Yes / Died / 24-Aug-18
5-Aug-18: 41 / M / Yes / No / Eastern / Dammam / 1-Aug-18 / 3-Aug-18 / No / Yes / Yes / Survived
17-Aug-18: 80 / M / Yes / No / Al-Bahah / Baljurashi / 6-Aug-18 / 14-Aug-18 / Yes / No / Yes / Died / 18-Aug-18
30-Aug-18: 77 / M / Yes / No / Riyadh / Alzulfi / 19-Aug-18 . 27-Aug-18 / Yes / No / Yes / Survived
31-Aug-18: 55 / F / Yes / No / Riyadh / Aldwadmi / 22-Aug-18 / 29-Aug-18 / Yes / No / Yes / Survived
2-Sep-18: 56 / F / Yes / No / Al-Qassim / Bukiriah / 24-Aug-18 / 31-Aug-18 / Yes / No / Yes / Survived
11-Sep-18: 64 / M / Yes / No / Al-Ahsaa / Hofouf / 2-Sep-18 / 10-Sep-18 / No / Yes / Yes / Survived
16-Sep-18 38 / M / No / No / Riyadh / Rumah / 9-Sep-18 / 14-Sep-18 / Yes / No / Yes / Survived
Note: UI = Under Investigation

From 2012 through 16 Sep 2018, the total global number of laboratory-confirmed MERS cases reported to WHO is 2254 and 800 associated deaths.

The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR 2005 to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment
Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained 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 camels) or a 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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communicated by:
ProMED-mail rapporteur Mary Marshall
and
ProMED-mail rapporteur Marianne Hopp

[This WHO update is very helpful to fill in some of the gaps in demographics. To summarize, in the period of this update (1 Jun 2018 - 16 Sep 2018), there were a total of 32 newly confirmed cases of MERS-CoV reported from Saudi Arabia to WHO, bringing the global total of cases to 2254 including 800 associated deaths (reported case fatality rate of 35.5%.

The 32 cases came from Riyadh (11), Najran (7), Al Qasim (6), Northern (2), Al Ahsaa (2), Jeddah (1), Tabouk (1), Eastern (1), and Al-Bahah (1).

Only 4 of the 32 cases reported during this period were in women, and only 4 were reported in non-Saudi nationals (expats). 23 of the cases had a history of co-morbidities (71.9%). 12 had a history of exposure to camels (37.5%); only one case was in a healthcare worker; all cases were symptomatic; and 10 of the cases were reported to have died (reported case fatality rate 31.3%).

What is impressive about this update are the clusters. Of the 5 clusters, only one involved the healthcare environment, while 4 were household clusters. One of the clusters involved 4 cases in household contacts that were part of a larger cluster that began in May 2018; the remaining 4 clusters involved 2 cases each. Hopefully, the days of large, nosocomial outbreaks are historical. - Mod.MPP]

See Also
MERS-CoV (39): Saudi Arabia (QS, RI) South Korea 20180929.6060992
MERS-CoV (38): Saudi Arabia (RI, QS) South Korea 20180916.6033021
MERS-CoV (37): Saudi Arabia (SH), South Korea ex Kuwait, WHO 20180912.6025675
MERS-CoV (36): Saudi Arabia, South Korea, contact tracing, WHO 20180911.6023092
MERS-CoV (35): South Korea ex Kuwait 20180908.6016517
MERS-CoV (34): Saudi Arabia (QS) clarification 20180906.6012360
MERS-CoV (33): Saudi Arabia: (QS) RFI 20180904.6006491
MERS-CoV (32): Saudi Arabia (QS) 20180903.6004712
MERS-CoV (31): Saudi Arabia (RI, QS), UK (England) ex Saudi Arabia, WHO 20180901.6002235
MERS-CoV (30): Saudi Arabia (RI) new case 20180830.5998414
MERS-CoV (20): Saudi Arabia (NJ) susp. family cluster 20180602.5835120
MERS-CoV (10): Oman, Saudi Arabia, WHO 20180315.5690014
MERS-CoV (01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman) 20180102.5532148
2017
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MERS-CoV (77): Saudi Arabia, camels, human, epidemiology, assessment 20171222.5520561
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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