MERS-COV (63): SAUDI ARABIA (AL QASIM, TABUK), WHO

Posted on 10TH OCT 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] Saudi Arabia, new cases - MOH 2-9 Oct 2017
[2] Saudi Arabia - WHO update 9 Oct 2017 (covering 31 Aug 2017 - 26 Sep 2017)

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[1] Saudi Arabia, new cases - MOH 2-9 Oct 2017
Date: Mon 9 Oct 2017
Source: Saudi MOH 2-9 Oct 2017 [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of Mon 9 Oct 2017, there have been a total of:
1723 laboratory-confirmed cases of MERS-CoV infection, including
698 deaths [reported case fatality rate 40.5 percent],
1010 recoveries, and
15 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 as they are reported. 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 [current through 20 Sep 2017], there have been a total of:
2 newly confirmed cases,
2 newly reported fatalities, and
2 newly reported recoveries.

Information on newly confirmed cases (2 cases):
9 Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-09-...

1 - A 77-year-old Saudi male, non-healthcare worker from Albukaria [Al Qaṣīm region] currently in critical condition. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness.

3 - Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-03-...

2 - A 72-year-old Saudi male, non-healthcare worker from Tabuk [Tabūk region] reported to be in stable condition at the time of confirmation. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness. Reported as a fatality on 9 Oct 2017.[see newly reported fatality no.1 below. - Mod.MPP]

Information on newly reported fatalities (2 fatalities):
9 Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-09-...

1 - A 72-year-old Saudi male, non-healthcare worker from Tabuk [Tabūk region] with a history of pre-existing co-morbidities. [see newly confirmed case No 2 above. - Mod.MPP]

4 Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-04-...

2 - A 52-year-old Saudi male, non-healthcare worker from Taif [Makkah region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 26 Sep 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]

Information on newly reported recoveries (2 recoveries)
6 Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-06-...

1 - A 31-year-old Saudi male, non-healthcare worker from Bisha [`Asīr region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 30 Sep 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

4 Oct 2017 (1 new case)
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-10-04-...

2 - A 76-year-old Saudi male, non-healthcare worker from Nafi [Riyadh region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 27 Sep 2017 at which time he was noted to be in stable condition. Classified as a primary case with high risk exposure history in the 14 days preceding onset of illness still under investigation. - Mod.MPP]

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Communicated by:
ProMED-mail

[In the 8 days since the last update there have been a total of 2 newly confirmed cases reported, one of whom was also reported as a fatality in today's report. The 2 cases came from different regions, one from Al Qasim and one from Tabuk. Maps showing the locations of all cases mentioned above can be found at the source URLs.

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 9 Oct 2017 (covering 31 Aug 2017 - 26 Sep 2017)
Date: 9 Oct 2017
Source: WHO Emergencies preparedness, response 9 Oct 2017
http://www.who.int/csr/don/09-october-2017-mers-saudi-arabia/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia 9 Oct 2017
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Between [31 Aug 2017 and 26 Sep 2017], the national IHR focal point of Saudi Arabia reported 9 additional cases of Middle East Respiratory Syndrome (MERS), including 4 deaths. In addition, 4 deaths from previously reported cases were reported.

Details of the cases
Among the 9 newly reported cases, one was associated with a MERS cluster in Dawmet Aljandal City, Al Jawf region, Saudi Arabia reported previously.

MERS-CoV cases reported between [31 Aug 2017 and 26 Sep 2017]:
Case no./ Date of notification to WHO / 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 Date of outcome /
1 / 2017-08-31 / Dawmet Aljandal / 21 / F / No / NA / NA / NA / Yes† / NA / NA / 2017-08-31 / Alive
2 / 2017-09-02 / Hail / 56 / M / No / Yes / Yes / Yes / No / 2017-08-28 / 2017-09-01 / 2017-09-02 / Alive
3 / 2017-09-05 / Hofuf / 37 / M / No / Yes / Yes / Yes / No / 2017-08-25 / 2017-09-02 / 2017-09-04 / Deceased / 2017-09-20
4 / 2017-09-06 / Riyadh / 78 / M / No / Yes / Yes / Yes / No / 2017-08-30 / 2017-09-04 / 2017-09-05 / Alive
5 / 2017-09-07 / Riyadh / 48 / M / No / Yes / NA / NA / NA / 2017-08-30 / 2017-09-05 / 2017-09-06 / Alive
6 / 2017-09-08 / Riyadh / 61 / F / No / Yes / NA / NA / NA / 2017-09-04 / 2017-09-06 / 2017-09-07 / Alive
7 / 2017-09-21 / Hofuf / 48 / M / No / Yes / Yes / Yes / No / 2017-09-15 / 2017-09-20 / 2017-09-21 / Alive
8 / 2017-09-21 / Hofuf / 72 / F / No / Yes / NA / NA / NA / 2017-09-14 / 2017-09-19 / 2017-09-20 / Deceased / 2017-09-21
9 / 2017-09-26 / Taif / 52 / M / No / Yes / Yes / Yes / No / 2017-09-10 / 2017-09-24 / 2017-09-26 / Alive

Globally, 2090 laboratory-confirmed cases of infection with MERS-CoV including at least 730 related deaths have been reported to WHO.

Public health response
The source of infection of the cases reported are under investigation by the Ministry of Health and Ministry of Agriculture (when dromedaries are involved) in Saudi Arabia. The Saudi Arabian Ministry of Health has identified and is following up health care workers and household contacts of known MERS patients. As per Saudi Arabian policy, listed contacts were not allowed to attend Hajj.

WHO risk assessment
MERS-CoV causes severe human infections resulting in high mortality. Close direct or indirect contact with infected dromedaries is the main source of primary human infections. MERS-CoV has demonstrated the ability to transmit between humans. So far, 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.

--
Communicated by:
ProMED-mail

[Reviewing the information provided in the WHO update comparing with information available through the MOH reports available at http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1:
Case 1 was an asymptomatic household contact of another confirmed cases and was reported as a recovery on 6 Sep 2017.
Case 2 was classified as a primary case with a history of indirect contact with camels and was reported as a fatality on 10 Sep 2017.
Case 3 had been reported as high risk exposure history still under investigation on the MOH report and was reported as a fatality on 21 Sep 2017.
Case 5 was reported as a recovery on 28 Sep 2017.
Case 6 was reported as a fatality on 13 Sep died.
Case 7 was reported as a recovery on 27 Sep 2017.
Case 9 was reported as a fatality on 4 Oct 2017.

In summary, of the 9 newly confirmed cases in the above WHO report, outcomes were known for 8 of the 9 cases, 5 of whom had fatal outcomes, With respect to high risk exposures, 5 of the 9 cases had a history of contact with camels in the 14 days preceding onset of illness, one was a household contact of a previously confirmed case, and 3 were classified as primary cases but high risk exposures in the 14 days preceding onset of illness had not been identified.

Of interest is that 4 of the 5 fatal cases had a history of contact with camels in the 14 days preceding onset of illness. Of additional note is that all of the 8 symptomatic cases of MERS-CoV infection had a history of pre-existing co-morbidities. - Mod.MPP

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

See Also

MERS-CoV (62): animal reservoir, camels, FAO, OIE, WHO 20171002.5354608
MERS-CoV (61): Saudi Arabia 20171001.5353977
MERS-CoV (60): UAE, Saudi Arabia, WHO 20170922.5334852
MERS-CoV (50): Saudi Arabia 20170806.5232071
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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