MERS-COV (71): OMAN, SAUDI ARABIA (AL QASIM), WHO

Posted on 12TH 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 - WHO update 10 Nov 2017
[2] Saudi Arabia, 1 new case - Saudi MOH 7-10 Nov 2017
[3] Saudi Arabia - WHO update 7 Nov 2017 (27 Sep - 31 Oct 2017)

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[1] Oman - WHO update 10 Nov 2017
Date: Fri 10 Nov 2017
Source: WHO Emergencies preparedness, response, DONs 10 Nov 2017 [edited]
http://www.who.int/csr/don/10-november-2017-mers-oman/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Oman 10 Nov 2017
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On [Wed 1 Nov 2017], the International Health Regulations (2005) national focal point of Oman reported one case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Prior to this case, the most recent case of MERS-CoV from Oman was reported on [Wed 30 Aug 2017].

Details of the case
The patient, a 27-year-old male living in Sharqiyah Region, reported contact with dromedaries prior to symptom onset. Details of the case reported to WHO can be found in a separate document (see link below).

MERS-CoV case reported on [1 Nov 2017]
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
2017-11-01 / Sharqiyah / 27 / M / No / NA / Yes / No / No / 2017-10-21 / 2017-10-28 / 2017-11-01 / Alive

Globally, 2103 laboratory-confirmed cases of infection with MERS-CoV including at least 733 related deaths have been reported to WHO.

Public health response
Investigations are ongoing into the source of infection and exposure to other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture has been informed and investigations into dromedaries are ongoing. Contact tracing and follow up of 10 family contacts and all health care workers at the hospital/s where the patient was treated are ongoing. All identified contacts are monitored for 14 days from the last date of exposure.

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. Close direct or indirect contact with infected dromedaries is the source of human infections in the community.

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.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[With the inclusion of this case, there have now been a total of 2103 laboratory confirmed cases of MERS-CoV infection including at least 733 related deaths reported to WHO since April 2012. We await further follow-up on the outcome of this case as well as the outcome of the contact monitoring. See MERS-CoV (70): Oman (SN), Saudi Arabia (RI) 20171106.5427278 for additional details on the investigation surrounding this case.

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. - Mod.MPP]

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[2] Saudi Arabia, 1 new case - Saudi MOH 7-10 Nov 2017
Date: Fri 10 Nov 2017
Source: Saudi MOH 7-10 Nov 2017 [edited]
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

As of Fri 10 Nov 2017, there have been a total of:
1738 laboratory-confirmed cases of MERS-CoV infection, including
703 deaths [reported case fatality rate 40.4 percent],
1016 recoveries, and
18 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. Another complication is delayed reporting of cases - Mod.MPP]

Since the last ProMED-mail update 6 Nov 2017, there have been a total of:
1 newly confirmed case,
2 newly reported fatalities, and
0 newly reported recoveries.

Information on newly confirmed case (1 case)
Date: 9 Nov 2017
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-11-09-...

- A 77-year-old Saudi male, non-healthcare worker from Al Bukayriyah [Al Qaṣim region] 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.

[Please note that on reviewing the reports for this posting, I found an additional case had been reported on 24 Oct 2017 -- 77-year-old Saudi male, non-healthcare worker from Riyadh [Riyadh region] noted to be in stable condition and classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of his illness. - Mod.MPP]

Information on newly confirmed fatalities (2 fatalities)
Date: 9 Nov 2017
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-11-09-...

1 - A 72-year-old Saudi male non-healthcare worker from Tabuk [Tabuk region] with a history of pre-existing co-morbidities. [There was a 72-year-old Saudi male from Tabuk reported as a newly confirmed case on [Tue 3 Oct 2017] and as a fatality on [Mon 9 Oct 2017]. Since then the only other case reported from Tabuk was the 56-year-old Saudi male reported as fatality no. [2] below in this report. The most recent case reported from Tabuk preceding 3 Oct 2017 was on 12 Nov 2017. - Mod.MPP]

Date: 7 Nov 2017
https://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2017-11-07-...

2 - A 56-year-old Saudi male non-healthcare worker from Tabuk [Tabuk region] with a history of pre-existing co-morbidities. [Reported as a newly confirmed case on [Thu 26 Oct 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.

--
Communicated by:
ProMED-mail

[It is important to mention that numbers of reported MERS-CoV infections, fatalities and recoveries reported by the Saudi MOH are subject to change as more information becomes available. We/I try our/my best to present accurate numbers, but as more information becomes available, it requires retrospective correction of tallies, etc.

One of the challenges in the above report is reconciling the reported fatality (no.1) - the 72-year-old male from Tabuk. As mentioned above, there was a report of a fatality of a 72-year-old male from Tabuk on [Mon 9 Oct 2017], with date of initial report of laboratory confirmation of MERS-CoV infection on [Tue 3 Oct 2017]. I am unable to identify if this is a duplicate report of the fatality, or a report of an additional fatality where the age and location may be different than stated in this report. Clarification of this would be greatly appreciated.

That being said, with the addition of the newly confirmed case reported on [Thu 9 Nov 2017], and the delayed report of the case reported on 24 Nov 2017, there have now been a total of 1738 laboratory-confirmed cases of MERS-CoV infection, including 703 deaths reported from Saudi Arabia since September 2012, with reported cases of MERS-CoV infection by Saudi Arabia representing more than 80 percent of all MERS-CoV infections reported to WHO worldwide.

Maps showing the locations of the newly confirmed MERS-CoV infected individuals and reported fatalities 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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[3] Saudi Arabia - WHO update 7 Nov 2017 (27 Sep - 31 Oct 2017)
Date: Tue 7 Nov 2017
Source: WHO Emergencies preparedness, response [edited]
http://www.who.int/csr/don/7-november-2017-mers-saudi-arabia/en/

Middle East respiratory syndrome coronavirus (MERS-CoV) - Saudi Arabia 7 Nov 2017
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Between [27 Sep 2017 and 31 Oct 2017], the National IHR Focal Point of the Kingdom of Saudi Arabia reported 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths. Additionally, one death from a previously reported case was reported to WHO.

Details of the cases
Detailed information concerning the cases reported can be found below:

MERS-CoV case reported between [27 Sep 2017 and 31 Oct 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 / 2017-09-27 / Buraidah / 76 / M / No / Yes / NA / NA / NA / 2017-09-21 / 2017-09-24 / 2017-09-26 / Alive
2 / 2017-09-30 / Bisha / 31 / M / No / Yes / Yes / Yes / NA / 2017-09-23 / 2017-09-28 / 2017-09-29 / Alive
3 / 2017-10-03 / Tabuk / 72 / M / No / Yes / Yes / Yes / NA / 2017-09-27 / 2017-09-30 / 2017-10-02 / Deceased / 2017-10-09
4 / 2017-10-09 / Buraidah / 77 / M / No / Yes / Yes / Yes / NA / 2017-09-28 / 2017-10-06 / 2017-10-08 / Deceased / 2017-10-17
5 / 2017-10-11 / Riyadh / 58 / M / No / Yes / NA / NA / NA / 2017-10-05 / 2017-10-09 / 2017-10-10 / Alive
6 / 2017-10-13 / Riyadh / 60 / M / No / Yes / Yes / Yes / NA / 2017-10-06 / 2017-10-11 / 2017-10-12 / Alive
7 / 2017-10-15 / Riyadh / 25 / M / No / No / Yes / Yes / NA / 2017-10-12 / 2017-10-14 / 2017-10-15 / Alive
8 / 2017-10-24 / Riyadh / 77 / M / No / Yes / Yes / Yes / NA / 2017-10-18 / 2017-10-22 / 2017-10-23 / Alive
9 / 2017-10-26 / Tabuk / 56 / M / No / Yes / Yes / Yes / NA / 2017-10-21 / 2017-10-23 / 2017-10-25 / Alive
10 / 2017-10-27 / Hofuf / 36 / M / No / Yes / NA / NA / NA / 2017-10-22 / 2017-10-24 / 2017-10-25 / Alive
11 /2017-10-29 / Taif / 59 / M / No / Yes / Yes / Yes / NA / 2017-10-21 / 2017-10-27 / 2017-10-29 / Alive
12 / 2017-10-30 / Taif / 76 / F / No / Yes / Yes / No / NA / 2017-10-27 / 2017-10-29 / 2017-10-30 / Alive

The 12 cases of MERS-CoV infection reported during this time period are from 6 regions of the country. Among the 12 cases, 9 reported contact with dromedaries and none have reported an epidemiological link with other known cases. Investigations into the source of infection for each case, including direct and/or indirect contact with dromedaries, are ongoing.

Globally, 2102 laboratory-confirmed cases of infection with MERS-CoV including at least 733 related deaths have been reported to WHO.

Public health response
The source of infection for each case reported is 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.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Reviewing the above cases from Saudi Arabia reported to the WHO, some additional information from the MOH reports (some of which have been reported after 30 Oct 2017). Cases 1, 2, 5, 6, 7 were reported as recoveries on 4 Oct, 6 Oct, 1 Nov, and 25 Oct respectively. Case one had originally been reported as from Nafi (Riyadh region), but in the above report is stated as from Buraidah. Case 6 had originally been reported from Jizan (Jizan region). Case 8 was most likely reported as a fatality on 1 Nov and case no. 9 was reported as a fatality on 7 Nov [2017].

Of note, there was another case reported on [Tue 31 Oct 2017] that is not reflected in the above report. A 49-year-old Saudi male from Unaizah (Al Qasim region) noted to be in critical condition at the time of confirmation report and reported as a fatality on [Mon 6 Nov 2017]. Classified as a primary case with a history of direct contact with camels in the 14 days preceding onset of illness. - Mod.MPP]

See Also

MERS-CoV (70): Oman (SN), Saudi Arabia (RI) 20171106.5427278
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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