MERS-COV (70): OMAN (ASH SHARQIYAH NORTH), SAUDI ARABIA (RIYADH)

Posted on 07TH NOV 2017
tagged MERS-CoV, Oman; 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] Oman, additional information - EpiCore Surveillance Project
[2] Saudi Arabia, 1 new case - MOH

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[1] Oman, additional information - EpiCore Surveillance Project
Date: Mon 6 Nov 2017
Source: EpiCore Global Surveillance Project [edited]

In response to an RFI sent through the EpiCore Surveillance Project requesting more information on the reported case of MERS-CoV infection in Oman, we received the following information from an EpiCore member.

The patient is a 27 yr old male from the North Sharqiyah governorate who sought medical help on [22 Oct 2017] at a health center and again on [24 Oct 2017] at a private clinic before finally being admitted to a hospital on [28 Oct 2017]. His presenting symptoms include fever, cough and dyspnea (shortness of breath). Bilateral pneumonia was confirmed. On [1 Nov 2017],an infection with the MERS-CoV was confirmed by the National Public Health Laboratory. There is ongoing tracing of all contacts including observation and continued follow-up.

The patient has a history of direct close contact with camels routinely on weekends.

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Communicated by:
ProMED-mail

[Many thanks to our EpiCore surveillance project members for their rapid reply to our RFI. Using the Saudi system of classification, this case would be considered a primary case with a history of direct contact with camels in the 14 days preceding onset of illness. We've also learned from a reliable source that the patient has been discharged from hospital and is home recovering.

MERS-CoV has previously been documented in Omani camels. In a 2013 Lancet publication, Reusken CB et al, found 50/50 (100 percent) of Omani camels to have protein specific antibodies against MERS-CoV spike to the MERS-CoV (1). In a 2014 Eurosurveillance report, Nowotny N and Kolodziejek J documented that nucleotide sequencing of camel derived MERS-CoV in Oman were closely related to human MERS-CoV sequences from the same geographic area (2). In 2015, 8 dromedary camels were transported to the UAE from Oman and were found to be RT-PCR positive for the MERS-CoV ORF 1A and upstream of E genes. Testing of the 2 men who accompanied these camels revealed while asymptomatic, they were also RT-PCR for the MERS-CoV (3).

1- Reusken CB, Haagmans BL, Muller MA, et al. Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study. Lancet Infect Dis. 2013 Oct;13(10):859-66. doi: 10.1016/S1473-3099(13)70164-6, available at:
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70164-6/fulltext

2- Nowotny N and Kolodziejek J. Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels, Oman, 2013. Euro Surveill. 2014;19(16):20781, available at:
http://www.eurosurveillance.org/content/10.2807/1560-7917.ES2014.19.16.2...

3- Al Hammadi ZM, Chu DK, Eltahir YM, et al. Asymptomatic MERS-CoV Infection in Humans Possibly Linked to Infected Dromedaries Imported from Oman to United Arab Emirates, May 2015. Emerg Infect Dis. 2015;21(12):2197-200. doi: 10.3201/eid2112.151132, available at:
https://wwwnc.cdc.gov/eid/article/21/12/15-1132_article

The HealthMap/ProMED map of Oman can be found at: http://healthmap.org/promed/p/124.

A map showing the governates of Oman can be found at: http://www.omansultanate.com/images/240px-oman_subdivisions.png. North Sharqiyah governorate is in the northeast of the country, just south of the Muscat governorate. - Mod.MPP]

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[2] Saudi Arabia, 1 new case - MOH
Date: Mon 6 Nov 2017
Source: Saudi MOH [edited]
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-11-06-...

As of Mon 6 Nov 2017, there have been a total of:
1736 laboratory-confirmed cases of MERS-CoV infection, including
701 deaths [reported case fatality rate 40.4 percent],
1016 recoveries, and
19 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 yesterday [5 Nov 2017], there have been a total of:
1 newly confirmed case,
1 newly reported fatality, and
0 newly reported recoveries.

Information on newly confirmed case (1 case)
- A 49-year-old Saudi male, non-healthcare worker from Riyadh [Riyadh region] noted to be in stable condition. Classified as a primary case with high risk exposure history currently under investigation.

Information on newly reported fatality (1 case)
- A 49-year-ol Saudi male, non-healthcare worker from Unaizah [Al Qaṣim region] with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 31 Oct 2017 at which time he was noted to be in critical condition. He was classified as a primary case with a history of indirect contact with camels in the 14 days preceding onset of illness. - Mod.MPP]

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Communicated by:
ProMED-mail

[Of note this is now the 4th newly confirmed case of MERS-CoV infection reported from Riyadh in the past 5 days. There was 1 case reported on 2 Nov 2017, 2 cases reported on 5 Nov 2017 and this case reported today (6 Nov 2017). All 4 cases are classified as primary cases with high risk exposure histories still under investigation. This may just be a coincidence as Riyadh is the major city and population center in Saudi Arabia; that being said, based on past observations, one can't help but wonder if something is going on in some healthcare facility, perhaps an outpatient facility leading to common exposures resulting in increased transmission of the MERS-CoV in Riyadh.

We await more information.

The HealthMap/ProMED map of Saudi Arabia can be seen at http://healthmap.org/promed/p/131.
There is a map of Saudi Arabia showing the location of today's reported case and fatality available at the source URL. - Mod.MPP]

See Also
MERS-CoV (69): Oman, Saudi Arabia (RI, QS) RFI 20171105.5425993
MERS-CoV (68): Israel, animal reservoir, camels, serology, surveillance 20171105.5425773
MERS-CoV (67): Saudi Arabia, South Korea, post disease sequelae 20171030.5413665
MERS-CoV (66): Burkina Faso, animal reservoir, camels, FAO, RFI 20171029.5411777
MERS-CoV (65): Saudi Arabia (RI, JZ) 20171017.5387011
MERS-CoV (64): Saudi Arabia, animal reservoir, human, camel milk 20171012.5375933
MERS-CoV (63): Saudi Arabia (QS, TB), WHO 20171009.5369268
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 (59): Oman, Saudi Arabia, WHO 20170913.5313874
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 (116): Oman, additional information 20161201.4669008
MERS-CoV (115): Oman, RFI 20161130.4664043
MERS-CoV (14): Thailand ex Oman, WHO 20160129.3976802
MERS-CoV (12): UAE, Oman, Saudi Arabia, WHO 20160126.3967808
MERS-CoV (10): Saudi Arabia (MK), Thailand ex Oman, RFI 20160125.3964309
MERS-COV (08): Thailand ex Oman, Saudi Arabia corr 20160124.3962172
MERS-COV (02): Oman, WHO 20160107.3918976
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 (74): South Korea, Saudi Arabia, Thailand ex Oman 20150621.3454450
MERS-CoV (70) - Thailand ex Oman, 1st report, RFI 20150618.3447631
MERS-CoV (71): Thailand ex Oman, South Korea, Saudi Arabia, UAE 20150618.3447481
MERS-CoV (56): South Korea, China, Saudi Arabia, Oman, WHO 20150605.3413986
MERS-CoV (52): Oman, Saudi Arabia, South Korea, WHO, RFI 20150531.3399248
MERS-CoV (14): Saudi Arabia, Oman, WHO 20150124.3114951
MERS-CoV (08): Oman, Saudi Arabia, WHO 20150117.3097488
MERS-CoV (06): Oman, new case, RFI 20150111.3085228
MERS-CoV (04): Oman, Saudi Arabia, RFI 20150108.3079584
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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