MERS-COV (56): UNITED ARAB EMIRATES, SAUDI ARABIA (AL JAWF, HAIL, RIYADH), WHO

Posted on 30TH AUG 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] UAE, 1 new case - WHO
[2] Saudi Arabia, 7 new cases - Saudi MOH 19-29 Aug 2017

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[1] UAE, 1 new case - WHO
Date: Mon 28 Aug 2017
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]
http://www.who.int/csr/don/28-august-2017-mers-uae/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - United Arab Emirates
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On [29 Jul 2017], the national IHR focal point of the United Arab Emirates reported one additional case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Details of the case
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MERS-CoV case reported on 29 July 2017*
Please note, data corresponds to Disease Outbreak News as published on [28 Aug 2017].
* Data subject to change due to ongoing investigations. Fields related to the final status of the case are updated as information is available.
NA = Not available

Date of notification to WHO / Reporting country / City of residence / Age / Sex / Health care worker / Comorbidities / Exposure to camels / Camel milk consumption / Exposure to MERS-CoV cases / Date of symptoms onset / Date of 1st hospitalization / Date of laboratory confirmation / Status
29 Jul 2017 / United Arab Emirates / Al Ain / 54 / M / No / No / NA / NA / No / 11 Jul 2017 / 25 Jul 2017 / Alive

The patient, who lives and works in Al Ain, United Arab Emirates, presented at a hospital in Al Ain on [16 Jul 2017]. On [16 Jul 2017], a chest X-ray showed pneumonia and he was treated with antibiotics and non-invasive ventilation. On [25 Jul 2017], his symptoms worsened and a sputum sample was collected and tested for MERS-CoV and influenza. On [26 Jul 2017], showing no signs of improvement, the patient was transferred to a 2nd hospital in Al Ain and placed in an intensive care unit.

A 2nd sputum sample was collected on [26 Jul 2017] and both samples tested positive for MERS-CoV on [27 Jul 2017]. The patient is currently in ICU on mechanical ventilation. Investigations into the source of infection are ongoing. At the time of writing the results of the investigation were not yet provided to WHO.

Globally, 2067 laboratory-confirmed cases of infection with MERS-CoV including at least 720 related deaths have been reported to WHO.

Public health response
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The Ministry of Health in Abu Dhabi carried out contact tracing and followed up 89 health care workers and 95 contacts at his place of employment. All identified contacts were monitored for 14 days from the last date of exposure. No additional cases were detected.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[I have been unable to find additional information on both official sources as well as unofficial sources of information related to the case described in the UAE in the above WHO report. Of note is that the event (identification of a MERS-CoV infected individual) actually occurred a month ago -- the date of report of this case to WHO was 29 Jul 2017, with the date of onset of symptoms 11 Jul 2017 and date of positive laboratory testing for MERS-CoV of 25 Jul 2017. Information on results of contact tracing continuing until 14 days following last known contact with the case (one incubation period) was available for all contacts. Hence, this is a nice historical archive of identification of a sporadic case of MERS-CoV infection, although the information on the investigation of possible high risk exposures of the actual case is not available at present.

This is now the 5th case of MERS-CoV infection identified in the UAE this year, with 2 previous cases in May 2017 from Al Ain, and 2 additional previous cases from Abu Dhabi reported in April 2017, bringing the total number of cases reported by the UAE since 2012 up to 84.

Al Ain is a major inland city of the UAE, belonging to the Abu Dhabi emirate (see https://www.mapsofworld.com/united-arab-emirates/maps/united-arab-emirat...).

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

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[2] Saudi Arabia, 7 new cases - Saudi MOH 19-29 Aug 2017
Date: Tue 29 Aug 2017
Source: Saudi MOH 19-29 Aug 2017 [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of [Tue 29 Aug 2017], there have been a total of:
1708 laboratory-confirmed cases of MERS-CoV infection, including
688 deaths [reported case fatality rate 40.3 percent],
997 recoveries, and
22 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. One complication is the reporting of cases as either recoveries or deaths that cannot be confirmed as previously reported newly confirmed cases. - Mod.MPP]

Since the last ProMED-mail update [Fri 18 Aug 2017], there have been a total of:
7 newly confirmed cases
1 newly reported fatality, and
6 newly reported recoveries.

Information on newly reported cases (7 cases):
Date: 27 Aug 2017 (1 case)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-27-0...

1- A 33-year-old Saudi female, non-healthcare worker from Dawmat Aljandal [Al Jawf region] noted to be in stable condition. Classified as a primary case with high risk exposure history still under investigation at time of report.

Date: 26 Aug 2017 (3 cases)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-26-0...

2- A 10-year-old Saudi female, non-healthcare worker from Dawmat Aljandal [Al Jawf region] noted to be in stable condition, having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary case in a household contact.

3- A 14-year-old Saudi female, non-healthcare worker from Dawmat Aljandal [Al Jawf region] noted to be in stable condition, having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary case in a household contact.

4- A 50-year-old Saudi male, non-healthcare worker from Dawmat Aljandal [Al Jawf region] noted to be in stable condition. Classified as a secondary case in a household contact.

Date: 24 Aug 2017 (2 cases)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-24-0...

5- A 40-year-old Saudi female, non-healthcare worker from Dawmat Aljandal [Al Jawf region] noted to be in stable condition. Classified as a primary case with high risk exposure history still under investigation.

6- A 46-year-old Saudi male, non-healthcare worker from Hayel [Ḥā'il region], noted to be in critical condition. Classification still under review at the time of initial report.

Date: 21 Aug 2017 (1 case)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-21-0...

7- A 48-year-old Saudi male, non-healthcare worker from Alaflaj [Riyadh region] 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.

Information on newly reported fatality (1 fatality)
Date: 27 Aug 2017
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-27-0...

- A 67-year-old expat male, non-healthcare worker from Madinah [Al Madinah region] with a history of pre-existing co-morbidities [reported as a newly confirmed case on [15 Aug 2017] noted to be in stable condition. Classified as a primary case with a history of indirect contact with camels in the 14 days preceding onset of illness. - Mod.MPP]

Information on newly reported recoveries (6 recoveries)
Date: 25 Aug 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-25-0...

1- A 17-year-old Saudi male, non-healthcare worker from Dawmat Aljandal [Al Jawd region] with no history of co-morbidities. [reported as a newly confirmed case on [7 Aug 2017] at which time he was noted to be in stable condition. Classified as a secondary case in a household contact. - Mod.MPP]

Date: 24 Aug 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-24-0...

2- A 12-year-old Saudi male, non-healthcare worker from Dawmat Aljandal [Al Jawd region] with no history of co-morbidities. [reported as a newly confirmed case on [7 Aug 2017] at which time he was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary infection in a household contact. - Mod.MPP]

Date: 21 Aug 2017 (3 recoveries)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-21-0...

3- A 25-year-old expat female, healthcare worker from Dawmat Aljandal [Al Jawd region] with no history of co-morbidities. [reported as a newly confirmed case on [6 Aug 2017] at which time she was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary healthcare acquired infection in a healthcare worker. - Mod.MPP]

4- A 27-year-old expat female, healthcare worker from Dawmat Aljandal [Al Jawd region] with no history of co-morbidities. [reported as a newly confirmed case on [8 Aug 2017] at which time she was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary healthcare acquired infection in a healthcare worker. - Mod.MPP]

5- A 49-year-old expat male, healthcare worker from Dawmat Aljandal [Al Jawd region] with no history of co-morbidities. [reported as a newly confirmed case on [8 Aug 2017] at which time he was noted to be in stable condition having been identified as an asymptomatic contact of a previously confirmed case. Classified as a secondary healthcare acquired infection in a healthcare worker. - Mod.MPP]

Date: 20 Aug 2017 (1 recovery)
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-08-20-0...

6- A 44-year-old expat female, non-healthcare worker from Jeddah [Makkah region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on [4 Aug 2017] at which time she was noted to be in stable condition. Classified as a secondary case in a household contact. Note that there was a recovery reported in a 44-year-old expat female on 15 Aug 2017, suggesting either this is a duplicate report or there was a 2nd 44 year old expat female from Jeddah reported that did not appear on the newly confirmed case reports on the Saudi MOH website. - Mod.MPP]

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Communicated by:
ProMED-mail

[In the 11 day period since the last update, there have been 7 newly confirmed cases reported of whom 5 were from Dawmat Aljandal (Al Jawf region), the location that had nosocomial transmission identified since the beginning of this past month [July 2017]. Clearly transmission is continuing in this area, with 3 newly confirmed secondary cases in household contacts - at least 2 of whom were identified through screening of asymptomatic household contacts, and 2 additional cases in which high risk exposures are still under investigation. We do not know if these household contacts are associated with the earlier identified transmission chain in Dawmat Aljandal or if these are newly identified chains of transmission. The other 2 newly confirmed cases involve "sporadic" cases - an individual in Hail whose high risk exposure history is still under investigation, and an individual from Alaflaj (Riyadh region) with a history of direct contact with camels in the 14 days preceding onset of illness.

As to be expected, concern is being voiced on the international level with the upcoming Hajj and this recent increase in cases reported both in Saudi Arabia and in the UAE. We now have gone through 5 Hajj periods since the identification of the MERS-CoV and to date there have been no cases of MERS-CoV infection identified in returning Hajjis. The case in the UAE (see section [1] above) actually had onset of illness over 1 month ago with no secondary cases/infections identified among known contacts of this case. As for the cases in Saudi Arabia, and more specifically the Hajj, population movement is very well defined during the Hajj, no camels are permitted in the areas where Hajjis are congregated, and there are Hajj specific health services that are separate from those that are available for the general Saudi population, all factors that are reducing the likelihood of Hajjis having inadvertent (or intentional) high risk exposures. Hopefully my optimism is well placed and we will pass through a 6th Hajj period without impact on international transmission of the MERS-CoV associated with this Hajj.

Maps of Saudi Arabia showing the locations of the reported cases, fatality and recoveries can be found at the given URL's. The HealthMap/ProMED map of Saudi Arabia can be found at: http://healthmap.org/promed/p/131. - Mod.MPP]

See Also
MERS-CoV (55): Saudi Arabia (MK, MD, BA), WHO 20170819.5260102
MERS-CoV (54): Saudi Arabia (JF) nosocomial transmission 20170811.5244266
MERS-CoV (53): Saudi Arabia (JF), nosocomial transmission 20170810.5242142
MERS-CoV (52): Saudi Arabia (JF,AS,MD) nosocomial transmission 20170808.5235847
MERS-CoV (51): Saudi Arabia (HA, JF) 20170808.5234663
MERS-CoV (50): Saudi Arabia 20170806.5232071
MERS-CoV (49): Saudi Arabia, new cases 20170802.5223376
MERS-CoV (46): Saudi Arabia, WHO 20170707.5158219
MERS-CoV (45): Saudi Arabia (HA), Lebanon ex Saudi Arabia, WHO 20170705.5153627
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 (30): Saudi Arabia (RI,MD,MK) 20170602.5077920
MERS-CoV (20): Qatar, Saudi Arabia, WHO 20170404.4947466
MERS-CoV (10): Saudi Arabia (SH, MK) 20170202.4811346
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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