MERS-COV (45): SAUDI ARABIA (HAIL) LEBANON ex SAUDI ARABIA, WHO

Posted on 06TH JUL 2017
tagged MERS-CoV, Lebanon; 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, 1 new case - Saudi MOH 2-5 Jul 2017
[2] Lebanon - WHO, 4 Jul 2017

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[1] Saudi Arabia, 1 new case - Saudi MOH 2-5 Jul 2017
Date: 5 Jul 2017
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of today [Wed 5 Jul 2017], there have been a total of:
1673 laboratory-confirmed cases of MERS-CoV infection, including
679 deaths [reported case fatality rate 40.6 percent],
978 recoveries, and
16 currently active cases/infections.

[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; my spreadsheet counts asymptomatic infections.]

Since the last ProMED-mail update [1 Jul 2017], there have been a total of:
1 newly confirmed case/infection
1 newly reported fatality, and
4 newly reported recoveries.

Information on newly confirmed case/infection with MERS-CoV
Date: Tue 4 Jul 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-07-05-0...

- A 57-year-old Saudi female, non-healthcare worker, from Hail [Ḥā'il Region] currently in stable condition. Classified as a primary case with high risk exposure history still under investigation.

Information on newly reported fatality:
Date: Wed 5 Jul 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-07-05-0...

- A 27-year-old expat male, non-healthcare worker from Riyadh [Riyadh region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 5 Jun 2017 at which time he was noted to be in stable condition. At the time of initial confirmation report, he was classified as a secondary healthcare acquired case in a patient.

Information on newly reported recoveries (4 recoveries)
- All 4 were from Riyadh

Date: Wed 5 Jul 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-07-05-0...

1 - A 59-year-old expat male, non-healthcare worker, with a history of pre-existing co-morbidities, [reported as a newly confirmed case on 14 Jun 2017 at which time he was noted to be in critical condition. At the time of initial confirmation report classification was still pending further investigation. - Mod.MPP]

Date: Sun 2 Jul 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-07-02-0...

2 - A 25-year-old Saudi male, healthcare worker, with no co-morbidities [reported as a newly confirmed case on 8 Jun 2017 at which time he was noted to be in stable condition. Classified as a secondary healthcare acquired case in a healthcare worker. - Mod.MPP]

3 - A 34-year-old expat female, healthcare worker, with no history of co-morbidities [reported as a newly confirmed case on 9 Jun 2017 at which time she was noted to be in stable condition, having been identified as an asymptomatic contact of a previously confirmed MERS-CoV infected individual. Classified as a secondary healthcare acquired case in a healthcare worker. - Mod.MPP]

4- A 42-year-old expat male, non-healthcare worker, with no history of co-morbidities [reported as a newly confirmed case on 19 Jun 2017 at which time he was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed MERS-CoV infected individual. Classified as a secondary case in a household contact. - Mod.MPP]

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ProMED-mail

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[2] Lebanon - WHO, 4 Jul 2017
Date: 4 Jul 2017
Source: WHO Emergencies preparedness, response [edited]
http://www.who.int/csr/don/04-july-2017-mers-lebanon/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Lebanon 4 Jul 2017
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On [19 Jun 2017], the national IHR focal point of Lebanon reported one additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the case
A 39-year-old male Lebanese national living in Riyadh, Saudi Arabia developed mild symptoms on [8 Jun 2017]. As the patient was a health care worker, and due to enhanced Middle East respiratory syndrome (MERS) surveillance activities ongoing in Riyadh, a nasopharyngeal swab was collected on [11 Jun 2017] in Riyadh, Saudi Arabia, and tested negative for MERS-CoV by PCR at the Riyadh Regional Laboratory. The case is without a history of comorbid conditions. He does not work in a health care facility with active MERS patients, has not had contact with an identified confirmed MERS case, nor has had known contact with a patient with respiratory illness. He has no history of contact with dromedaries in the 14 days prior to the onset of the symptoms.

On [11 Jun 2017], the case travelled from Saudi Arabia to Lebanon and reported that he had no symptoms while travelling. On [15 Jun 2017], he developed gastrointestinal symptoms, and a medical investigation was initiated on the same day in Lebanon, whereupon a chest X-ray confirmed the diagnosis of pneumonia. A lower respiratory specimen was collected on [16 Jun 2017] and tested positive for MERS-CoV. The case was reported to the Ministry of Public Health on the same day. The case was placed in home isolation. The case has been asymptomatic since [17 Jun 2017], and 2 consecutive nasopharyngeal swabs and one lower respiratory sample were collected and tested negative for MERS-CoV by PCR, on [17, 19 and 23 Jun 2017], respectively. The patient was released from home isolation on [23 Jun 2017]. All contacts in Lebanon have tested negative for MERS-CoV. Contact tracing in Saudi Arabia and the source of infection are under investigation by the Ministry of Health in Saudi Arabia.

Information on newly reported case from Lebanon:
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 / 2017-06-19 / Riyadh‡ / 39 / M / Yes / No / No / No / No / 2017-06-08 / NA / 2017-06-16 / Alive
‡Country of residence is different to reporting country

Globally, 2037 laboratory-confirmed cases of infection with MERS-CoV including at least 710 related deaths have been reported to WHO.

Public health response
During the investigation of this case, the Ministry of Public Health evaluated the case and his contacts and implemented measures to limit further human-to-human transmission. These measures included:
- Proper isolation for confirmed cases (home isolation for asymptomatic patients, and in hospital for symptomatic patients).
- Active tracing for all contacts of patients, exposed health care workers and community contacts in Lebanon.
- Identification and contact and follow up of contacts in Saudi Arabia and investigation into the patient's source of infection, in collaboration with the Ministry of Health in Saudi Arabia.
- Identification of high and low risk contacts among health care workers with daily monitoring for all during incubation period of the 14 days, and performing laboratory testing with nasopharyngeal swabs from all exposed health care workers, regardless of the development of symptoms. All tests among contacts have been negative.
- Identification of high and low risk contacts among households with daily monitoring for all during incubation period of the 14 days, and PCR testing for symptomatic contacts. No symptoms were observed among household contacts.
- Enforcement of infection prevention and control measures at the hospital.
- Sending positive specimens to reference labs for confirmation and sequencing.

The Ministry of Public Health in Lebanon is communicating with the Ministry of Health in Saudi Arabia for follow up of health care workers and social contacts of the patient while he was in Saudi Arabia. The patient had not worked in a health care facility where recent MERS cases have been reported, but had initially been tested in Riyadh on [11 Jun 2017] as part of enhanced surveillance activities in Riyadh due to the clusters of MERS cases previously reported in the Disease Outbreak News published on [13 Jun 2017, 19 Jun 2017, and 28 Jun 2017].

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 non-sustained human-to-human transmission has occurred mainly in health care settings. This is the 2nd case of laboratory-confirmed MERS-CoV reported from Lebanon. One case of MERS has previously been reported in Lebanon on 8 May 2014 (See Disease Outbreak News published on 15 May 2014).

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 assessments based on the latest available information.

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Communicated by:
ProMED-mail

[Today's update has, in essence, 2 newly confirmed cases related to MERS-CoV transmission in Saudi Arabia. One, reported on 4 Jul 2017 by the Saudi MOH, is an individual from Hail whose possible high risk exposures are still under investigation. The other is the case reported by Lebanon with a history of living in Riyadh Saudi Arabia (see MERS-CoV (44): Lebanon ex Saudi Arabia, Saudi Arabia, exp. antiviral, RFI 20170701.5144892 for initial reports of this case). Of interest is that this individual is a healthcare worker working in a facility in Riyadh with no known MERS-CoV infected individuals and did not have a history of caring for individuals with a history of respiratory illnesses. Looking at his clinical illness, he appeared to have had mild respiratory symptoms on 11 Jun 2017, at which time a PCR of a nasopharyngeal swab was negative for the MERS-CoV. Four days later, he had the onset of gastrointestinal symptoms, was found to have pneumonia, and a lower respiratory specimen taken on 16 Jun 2017 was found to be positive for MERS-CoV. So, perhaps looking at patients seen with gastrointestinal symptoms as possible exposures in his case might point to possible missed MERS-CoV infected individuals. Of note is the prior observation that upper respiratory specimens did not necessarily have a high capture rate for PCR testing for the MERS-CoV in the past, so it is possible this infection was missed due to the nature of the testing specimen. Or perhaps at that time he did not have MERS-CoV infection but may have been exposed at the time of seeking healthcare assistance (to be a devil's advocate...).

According to the WHO update, there have now been a total of 2037 laboratory confirmed cases of MERS-CoV infection, including at least 710 related deaths reported globally (reported case fatality rate at least 34.9 percent).

Maps showing the locations within Saudi Arabia for reported cases and deaths can be found at the source URLs in the update report.

HealthMap/ProMED maps can be found at:
Saudi Arabia: http://healthmap.org/promed/p/131
Lebanon: http://healthmap.org/promed/p/85.
- Mod.MPP]

See Also

MERS-CoV (44): Lebanon ex Saudi Arabia, Saudi Arabia, exp. antiviral, RFI 20170701.5144892
MERS-CoV (43): Saudi Arabia, WHO 20170628.5137634
MERS-CoV (42): Saudi Arabia (RI, SH, MD), WHO 20170628.5136101
MERS-CoV (41): Saudi Arabia (RI, SH) 20170620.5117143
MERS-CoV (40): animal reservoir, camels, review, FAO 20170619.5115999
MERS-CoV (39): Saudi Arabia (RI), nosocomial transmission 20170615.5108781
MERS-CoV (38): Saudi Arabia (RI), nosocomial transmission, WHO 20170613.5102806
MERS-CoV (37): Saudi Arabia (RI), nosocomial transmission, fatal 20170611.5098598
MERS-CoV (36): Saudi Arabia (RI), nosocomial transmission
MERS-CoV (35): Saudi Arabia (RI), nosocomial and household transmission 20170608.5093008
MERS-CoV (34): Saudi Arabia, UAE, Qatar, WHO 20170606.5087888
MERS-CoV (33): Saudi Arabia (RI), nosocomial transmission 20170605.5085681
MERS-CoV (32): Saudi Arabia (RI,MD) 20170604.5083353
MERS-CoV (31): Saudi Arabia (MK,RI) nosocomial transmission 20170604.5082194
MERS-CoV (30): Saudi Arabia (RI,MD,MK) 20170602.5077920
MERS-CoV (27): Saudi Arabia (RI,AS,QS) nosocomial transmission 20170519.5049088
MERS-CoV (20): Qatar, Saudi Arabia, WHO 20170404.4947466
MERS-CoV (10): Saudi Arabia (SH, MK) 20170202.4811346
MERS-CoV (04): Saudi Arabia (MK, QS), nosocomial outbreak, RFI 20170110.4754928
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 (54): Saudi Arabia, Lebanon 20140509.2461876
MERS-CoV - Eastern Mediterranean (53): Saudi Arabia, Lebanon, RFI 20140509.2459095
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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