CDC warns U.S. doctors to watch for MERS.

MERS Chart From Saudi Arabia 2013.

CDC warns U.S. doctors to watch for MERS. HT: Croft.

Via KCCI.com, a CNN report: CDC warns U.S. doctors to watch for MERS. Excerpt:

The Centers for Disease Control and Prevention briefed U.S. healthcare providers by phone Thursday to put them on notice that MERS may be coming to an exam room near them via patients who have traveled to South Korea or countries in the Middle East.

The agency will issue a health advisory alerting health care providers about the signs and symptoms of the deadly Middle East respiratory syndrome, citing the potential for transmission from travelers from South Korea, where a MERS outbreak began in May. 

Health care providers were also reminded to ask their patients about whether they've traveled to South Korea or the Middle East, where the disease emerged in 2012. 

The MERS outbreak in South Korea is the largest outside the Middle East since the syndrome was identified three years ago. Since May 20, there have been 122 cases of the respiratory virus and 10 related deaths in South Korea. 

On the call, providers were asked to isolate suspected patients, follow protocols to protect themselves and to test for MERS without delay in patients with travel history to these areas. 

On paper, there is little to be afraid of, especially for healthy people in the community. MERS is essentially a nosocomial infection, one that spreads in the hospital setting and hits vulnerable people. Three-quarters of those infected already had respiratory illnesses. 

The precise way MERS spreads is not currently well understood, but it is likely via respiratory secretions, such as through coughing. However, the coronavirus is not highly contagious, and usually infects only people in close proximity. 

There are currently no known MERS cases in the United States, though two were reported last year. Both patients, who recovered, were health care workers infected while working in Saudi Arabia. Hmmm.....Viruses evolve constantly, i have this gut feeling this strain is different from the one seen in Saudi Arabia. 

Update:

As of Thursday, Korea has reported 10 MERS-related deaths. Over 3,800 are quarantined for possible infection.

FluTrackers Korean MERS-CoV Case List

Saudi Arabia: Camel meat lovers undeterred by MERS-CoV.

Saudi Arabia: Camel meat lovers undeterred by MERS-CoV. HT: Crof.

Via Arab News: Camel meat lovers undeterred by MERS. Excerpt:

Despite the spread of MERS coronavirus, many Saudis continue to drink fresh camel milk and many restaurants regularly serve dishes made with camel meat in spite of reports linking camels and virus infections. 

Nasser Al-Jarallah, director general of the department of slaughterhouses and public markets in Jeddah, said 1,130 camels were slaughtered in Jeddah in January. 

He pointed out that Jeddah municipality had focused its campaigns on camel milking sites and has closed a number of them in Al-Khumra district. 

Some camel owners who sell milk in Al-Nairiya, 150 km north of Jubail, said that sales had not changed and that people were not bothered by the coronavirus reports. They said that the price of a bowl of camel milk was SR20. 

According to a manager of a restaurant offering dishes made of camel meat, the price of a dish is about SR5 and the number of those eating camel meat has not been affected at all. “Most restaurants bring camel meat from the official slaughterhouses because that meat is free of disease,” he said. 

The Health Ministry has warned against contact with camels and recommended well-cooked camel meat and boiling the milk before drinking. 

Meanwhile, a recent study has shown that camels under the age of two years are the major source of corona infection from camels to humans. 

Abdul Aziz bin Saeed, assistant minister for public health, who heads the Health Ministry’s Command and Control Center (CCC), said the study, conducted in the UAE, showed that 96 percent in a group of 800 camels carried the virus

Camels emit MERS virus, Colorado State University researchers confirm

Camels emit MERS virus, Colorado State University researchers confirm. HT: Crof.

Via Colorado State University, a news release: Camels emit dangerous MERS virus, Colorado State University researchers confirm. Excerpt:

In a finding with global health implications, a research team led by a doctoral student at Colorado State University has confirmed for the first time that camels vent volumes of the deadly Middle East Respiratory Syndrome (MERS) virus, making them the likeliest suspect for spreading the pathogen to people. 

Now the CSU team is testing a vaccine that could keep camels from shedding the MERS virus, which has caused acute respiratory illness in about 900 people across the Arabian Peninsula since it was identified in 2012. 

The CSU researchers, partnering with an arm of the National Institutes of Health, demonstrated that infected camels shed large amounts of MERS virus, primarily through their nostrils. They also established for the first time that the virus develops in the animals’ upper respiratory system, and that camels shed infectious virus for up to a week. 

The findings were not surprising to many scientists who study viral infectious disease – camels have been a primary suspect as a source of MERS – yet confirming the source is essential to advancing science, knowledge and solutions. 

“This is a necessary step in looking at the interaction between the virus and the host species, the camel,” said Mark Pallansch, director of the Division of Viral Diseases in the Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. 

“We don’t have an effective intervention for stopping the spread of the virus other than standard hygiene precautions and avoiding contact with infected individuals,” Pallansch added. “This does provide a possible intervention to keep the host from infecting humans.”

The findings will appear in the December issue of Emerging Infectious Diseases, which is not online yet.

Saudi Arabia now starting MERS tests for camels and livestock.

Saudi Arabia now starting MERS tests for camels and livestock. HT: Croft.

Via Arab News: MERS tests for camels and livestock. Excerpt:

The Kingdom has started testing camels in the country for the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV), according to Minister of Agriculture Fahd Balghuneim. 

Speaking at a workshop in Riyadh recently on registering and numbering livestock in the country, Balghuneim said the ministry would start testing all livestock in the Kingdom starting next week to make sure they do not have MERS. 

He said there would be coordination with the Saudi Wildlife Authority to take samples from wild animals kept in nature reserves to determine the level of coronavirus infection in the Kingdom. 

He said there is no suitable equipment to conduct speedy tests for coronavirus. Officials have to take blood or mucus samples, which takes a long time. 

Balghuneim confirmed that there are no tests for the coronavirus at quarantine sites in countries exporting animals to Saudi Arabia. 

He said the measure is part of the ministry’s program to control the spread of infectious diseases. Livestock entering the Kingdom just before Ramadan would be quarantined and vaccinated in exporting countries. 

“We started registering and numbering livestock last year in Um Raqaiba. We started with camels belonging to Prince Mishal bin Abdulaziz to encourage other camel owners to do the same. Next week we will speed up the operation. The numbering of livestock will include sheep and camels in Badia through contractors working for the Ministry of Agriculture,” he said.

How MERS could topple the House of Saud, and beyond

How MERS could topple the House of Saud, and beyond. HT: Croft.

The Tyee has published my article How MERS Could Topple the House of Saud, and Beyond. Excerpt:

Statistically, the bug now known as Middle East respiratory syndrome coronavirus (MERS-CoV) is a trivial threat. In the two years we've known about it, the World Health Organization has officially recognized just 635 cases of MERS, with 193 deaths. All appear to have originated in the Middle East, chiefly Saudi Arabia and the United Arab Emirates. 

By comparison, Saudi Arabia suffered 6,596 traffic fatalities in 2010, and about 20 per cent of the people in the Persian Gulf region suffer from diabetes. 

But look again at those MERS deaths: a 30 per cent case fatality rate, where SARS had a rate of eight per cent. A disease that deadly will get attention, especially when it comes from a previously unknown virus and it flourishes in hospitals. 

The Gulf monarchies also have political reasons to fear MERS, and Saudi Arabia just announced that it's been fudging the case numbers for a year -- a confession likely to have major repercussions.Read the full story here.

CIDRAP on the new Saudi MERS numbers '133 detections including 92 fatal cases'

CIDRAP on the new Saudi MERS numbers '133 detections including 92 fatal cases' HT: Croft.

Via CIDRAP, Robert Roos writes: Review raises Saudi MERS case count 20%, death toll 48%. After summarizing the KSA MOH statements today, the post concludes:

Experts who commented on today's announcement welcomed the Saudi move toward greater transparency and expressed hope that it continues and increases. 

Connie Savor Price, MD, chief of infectious diseases at Denver Health and Hospital, commented, "When the new [minister of health] came into office, I do believe one of his priorities was to re-examine the data to ensure experts were getting accurate data to inform interventions. More rigorous case findings identified the additional cases and deaths that you heard about today. My sense is that most of these cases are healthcare associated." 

She denied any knowledge of the reasons for Memish's dismissal, but said she found the timing of today's announcement "interesting." 

"The MOH seems to want to be clear that they are here to collaborate and value transparency. That is a step in the right direction," she added. 

Michael T. Osterholm, PhD, MPH, who has done consulting work on MERS-CoV in the Middle East, said it's unclear why the additional cases were not reported earlier and what implications they have for understanding the MERS outbreak in Saudi Arabia. He is director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News. 

"We welcome this new level of transparency and hope it will continue with more detailed information about these cases and what will be done so that this doesn't happen in the future," he said. 

"It also reinforces the point that we need much more information about the risk factors for transmission, which can be answered only by the completion of a comprehensive case control study.  

"The bottom line message that we've got to understand is that this is not a Kingdom of Saudi Arabia problem or even a Middle East problem; this is an international problem," he said. "All it would take is one super-shedder of this virus to land in Tokyo or New York or London or Toronto, and this situation would turn on a dime."

Related:

Via his VDU's blog, Dr. Ian Mackay writes: MERS-CoV charting on hold after 113 new cases reported without details... Excerpt:

With the announcement overnight that a bunch (133 detections including 92 fatal cases) of old laboratory confirmed MERS-CoV detection had been found, but without any specific data to identify them, I will not be posting any further MERS-related charts. 

I believe there is a big WHO Disease Outbreak News update coming soon and it will provide all the detail - we bloggers will need to take a week off from our day jobs to add this detail to our line lists - but I'll resume charts some time after those data appear. 

This is all obviously being dumped at the feet of the stood down Deputy Minister of Public Health whose reputation for total control was well reported. Let's not forget that Minister, Abdullah al-Rabeeah, was stood down 21-April by King Abdullah. While Prof Memish obviously loved a good paper, and that was his chosen method of science communication (I've talked about that as a less-than-ideal route for public health matters), but I personally have no evidence for or against the scope of his control over this latest debacle. 

This is Acting Health Minister Adel Faqih's second try for "transparency" in reporting MERS. On the first try, we were all impressed with the new details, until the details began to vanish and the infographics had nothing new. This time we have tables plus infographics, and one big announcement, but we need a lot more.

Especially we need a lot more specialists in the KSA MOH to tell the Acting Minister that he can't fire his way to a MERS-free Kingdom by the start of the next Hajj in October. 

All he can really do is tell the world the truth, the whole truth, and nothing but the truth, and hope the world will help him find the answer.

MERS reaches Iran; India: Suspected case of MERS in Mangalore; cases slowing in Saudi Arabia

CIDRAP: MERS reaches Iran; India: Suspected case of MERS in Mangalore; cases slowing in Saudi Arabia. HT: Croft.

CIDRAP was off for Memorial Day yesterday, but it's caught up rapidly today. For starters, Robert Roos has a major story: MERS reaches Iran; cases slowing in Saudi Arabia. Excerpt:

Iran yesterday reported its first two cases of MERS-CoV (Middle East respiratory syndrome coronavirus), according to media reports, while Saudi Arabia has now gone 2 days without reporting any new cases, after announcing eight on May 24 and 25. 

In addition, the media reported one new case in Jordan on May 25, for a total of 11 cases reported since May 23. 

The cases in Iran involved two sisters who were among four suspected case-patients in one family in the southeastern province of Kerman, according to a Reuters story today. Word of the cases first surfaced yesterday in computer translations of an Iranian health ministry announcement. 

The cases were announced by Mohammad Mahdi Gouya, director-general of communicable diseases at the Iranian Health Ministry's Centre for Diseases Control and Prevention, the Reuters story said. 

"One of the sisters is in critical condition and the other is currently receiving treatment under special circumstances," Gouya said in a statement on the ministry's Web site. 

The story gave no other details about the two patients or their possible exposures to the virus. Gouya was quoted as saying that Iran had sent medical teams to Saudi Arabia, "where they studied MERS cases among Iranian Hajj pilgrims." But no MERS cases have previously been reported in Iran, nor were any confirmed cases reported among pilgrims who attended the 2013 Hajj last October. 

Iran becomes the 20th country, and the ninth in the Middle East, to identify MERS cases. Other Middle Eastern countries with cases are Saudi Arabia, the United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Yemen, and Lebanon.

Via The Hindu: Suspected case of MERS in Mangalore. Excerpt:

A suspected case of Middle East respiratory syndrome coronavirus (MERS-CoV) has been reported from Mangalore. Health authorities and Health Minister U.T. Khader confirmed this on Tuesday night. 

They said the victim, a 63-year-old woman, had been quarantined in a private hospital. The authorities are waiting for the report of samples of blood and respiratory secretion (“throat sample”) sent to the National Institute of Biologicals (NIB), Pune. The report is expected in a couple of days. 

This is the first suspected case of MERS in Karnataka after an alert was sent to airports in Bangalore and Mangalore where MERS screening facilities have been established. The woman had gone to Saudi Arabia on May 11 and returned on May 19. At the airport, the authorities advised her to get a check-up done for MERS as she was coughing. On May 22, she developed symptoms such as cold, fever and cough; following which she got herself admitted to the private hospital. Doctors, who suspected it to be a case of MERS, quarantined her. 

District Heath and Family Welfare Office H.S. Shivakumar said a test done at Kasturba Hospital in Manipal had suggested that it was only viral fever. However, the report from NIB would be conclusive. 

Mr. Khader said the health authorities had been asked to set up surveillance units at Mangalore and Bangalore international airports. When told that the authorities in Mangalore had said it would be set up by Thursday or Friday, Mr. Khader said he would expedite it. He said there was no need to sound any alert nor was there a need to coordinate with health authorities of neighbouring States.

Iran reports first MERS cases.

Iran reports first MERS cases. HT: Croft.

Thanks to Helen Branswell for tweeting about this story. Via the Iranian Ministry of Health and Medical Education: News> detect new virus 2 infection Corona Country / health consideration only way to prevent disease. Excerpt from a Google translation from Farsi:

Head of Communicable Disease Control, Ministry of Health of corona virus infection identified in 2 cases reported in the country. 

According to News and Information, Ministry of Health and Medical Education (Web Da), Dr. Mohammad Mahdi reportedly announced the news while adding 4 new suspected corona virus related to a family in the province have been observed in 2 cases infection has been confirmed that the two sisters in Kerman, one of them is ill and undergoing treatment in certain circumstances.

Google seems to have trouble with Farsi as it does with Arabic, but if I'm reading correctly, the Iranians have had two cases for some time and now have six—all in one family.

Meanwhile, the Iranian media are not eager to tell the world much about the new MERS cases there. But I'm working on it.

Saudi Arabia: Drop in MERS cases attributed to high temperatures

US - 16 being monitored in LA County for possible exposure to MERS (nothing to see, move along).

US -16 being monitored in LA County for possible exposure to MERS (nothing to see, move along). HT: CBSlocal.

KCAL9 News has learned that as many as 16 people in LA County are being monitored for possible exposure to MERS.

MERS stands for Middle East Respiratory Syndrome.

The California Department of Public Health says the 16 people were all passengers on a flight with a man who is now hospitalized with the disease in Florida.

The disease first appeared in the Middle East two years ago.

Worldwide, health officials say there have been about 650 reported cases with nearly one-third ending in death.

Three people in the United States were recently diagnosed with MERS. Two of the three people reportedly traveled into this country from Saudi Arabia.

MERS, like the similar disease SARS (Severe Acute Respiratory Syndrome) causes fever, coughing and often-fatal pneumonia.

Related:

Global MERS death toll passes 200

MERS - Cook camel meat well if you must eat.

MERS - Cook camel meat well if you must eat.(AN).

The Ministry of Health (MoH) has issued an advisory saying that eating camel meat and liver is safe as long as these animal products are cooked well. 

The ministry said that it is also safe to drink camel milk after boiling it at a high temperature, quoting experts who met at an international medical meeting in Riyadh recently. 

The meeting was attended by experts from the World Health Organization (WHO) and universities from Australia, Germany and Britain. 

The Kuwait News Agency (KUNA) had earlier reported that acting Health Minister Adel Fakeih had previously urged people to stay away from camel meat and milk to prevent coronavirus infection. 

The ministry said that it would come up with periodic updates about the virus, as well as set up three centers in Jeddah, Riyadh and Dammam to combat the disease. 

CNN reported earlier this month that evidence was mounting that camels are the lead suspects of the virus. 

Late last month, the Center for Infectious Disease Research and Policy (CIDRAP) reported that US and Saudi scientists found that MERS-CoV isolated from camels in Saudi Arabia matched samples from humans and can be grown in non-human primate cells in a lab, further augmenting the evidence that camels are a source of human infection.Hmmmm.....Neh....don't think it will get another Michelin star.

Related:  

MERS found in five racing camels in Oman

Dr. Mackay updates a MERS chart: 'festivals to avoid camel contact'

Dr. Mackay updates a MERS chart: 'festivals to avoid camel contact'  HT: Croft.

On his VDU's blog, Dr. Ian Mackay posts Snapdate: MERS-CoV detections by where they were probably acquired....

...yeah it's "probably" because sometimes it's just not clear to anyone. I've about 14 (554 in total) more cases attributed to a likely source in the Kingdom of Saudi Arabia (KSA) compared to the Ministry of Health tally on their website (540), but such is life. 

Anyway, I haven't updated this chart for 17-days (woah - sorry about that). The latest version now has the two major hospital-related outbreaks shown in pink - I'm still liking the Janadriyah festival as the possible source of community cases that then filter back throughout the country as visitors and tourists return to different areas or travel afterwards for other reasons. That would be on my 2015's "festivals that need to be tweaked to avoid camel contact" list. 

As per yesterday's post, these accumulation curves highlight that new detections of MERS-CoV have slowed right down in the KSA and in the United Arab Emirates (UAE). However, the UAE are now the reporting slow pokes, if the last batch posted by the World Health Organization is anything to go by, so we should stay tuned to what's happening there (and also stay tuned to the extent of upper respiratory tract signs and symptoms in those cases which continue to bug me).

Saudi Arabia: Six new MERS cases, four deaths, as of noon May 19.

Saudi Arabia: Six new MERS cases, four deaths, as of noon May 19. HT: Croft.

Via the KSA MOH English-language MERS page: MOH: '6 New Confirmed Corona Cases Recorded'. Excerpt:

Total numbers of confirmed cases in the last 24 hours: 6 cases. 

Recovered and discharged cases that previously tested positive and are now negative: 4 cases. 

The total number of deaths: 4 from previously confirmed cases.   

Overview of the Health Status of the Cases:   

• 2 stable cases 

• 3 cases without symptoms 

• 1 critical case in the ICU   

Summary of the cases:   

a) In Riyadh:   

1. A 45-year-old male, isolated at home. His condition is stable. He has been in contact with a confirmed case and does not have any symptoms. 

2. A 34-year-old man, isolated at home. His condition is stable. He has been in contact with a confirmed case and does not have any symptoms.   

b) In Jeddah:   

1. A 39-year-old man developed respiratory symptoms on May 6th, 2014. He was admitted to a government hospital on May 16th, 2014. On May 18th, 2014. He tested positive for MERS CoV. His condition is stable and he has been isolated at home. 

2. A 52-year-old man, isolated at home. His condition is stable. He has been in contact with a confirmed case and does not have any symptoms.   

c) In AlMadina:   

1. A 51-year-old man developed respiratory symptoms on May 3, 2014. He was admitted to a private hospital on May 13, 2014. He is in the ICU. May Allah grant him a speedy recovery.   

d) In Taif 

1. A 31-year-old man, suffering from heart disease. On May 11, 2014, he developed respiratory symptoms. On May 16, 2014, he was admitted to a government hospital. He has been isolated at the hospital.      

Deaths from previously reported cases:   

1. A 55-year-old male was admitted to a government hospital in Makkah. His case was previously reported on May 17th, 2014. He passed away on May 18th, 2014. May Allah rest his soul. 

2. A 28-year-old female was admitted to a private hospital in Jeddah. Her case was previously reported on May 7th, 2014. She passed away on May 18th, 2014. May Allah rest her soul. 

3. A 69-year-old female was admitted to a government hospital in Riyadh. Her case was previously reported on April 20th, 2014. She passed away on May 18th, 2014. May Allah rest her soul. 

4. A 32-year-old male was admitted to a government hospital in Tabuk. His case was previously reported on April 30th, 2014. He passed away on May 18th, 2014. May Allah rest his soul.  

Recovery from previously reported cases: 

1. A 40-year-old female in Jeddah was discharged from a government hospital on May 10th, 2014. 

2. A 58-year-old female from Makkah. Her latest tests for MERS-Corona virus were negative on May 18th, 2014. 

3. A 30-year-old female was discharged from a government hospital in Riyadh on May 18th, 2014. 

4. A 29-year-old female was discharged from a government hospital in Riyadh on May 18th, 2014.

It's unusual to see reports of asymptomatic confirmed cases being isolated at home. In Hong Kong, the Centre for Health Protection puts any contact of an imported H7N9 case straight into isolation in hospital until tests come back negative. The CHP would not enjoy operating under Saudi rules.

Related:

Possible MERS in India?

CDC interim MERS guidance for airline crews, what about passengers?

CDC interim MERS guidance for airline crews, what about passengers? HT: Croft.

CDC has published Middle East Respiratory Syndrome (MERS) Interim Guidance for Airline Crew: Report Ill Travelers on Flights Arriving to the United States. Click through for the full document and links. Excerpt:

This document provides interim guidance for the commercial airline industry about the Middle East Respiratory Syndrome (MERS). Because this is a new virus in humans, CDC is following this situation closely, and we are coordinating with our domestic and international partners. 

MERS situation update 

MERS is associated with severe respiratory illness and death, but is not very common. Some people who have traveled to the Arabian Peninsula and neighboring countries have been infected. It has also spread to several countries outside this region. These cases have had a direct or indirect connection to the Middle East and Saudi Arabia. 

MERS has spread between people who were in close and prolonged contact with an infected person, such as a family member or patients and health care workers in hospitals. 

See the links below for the latest updates. 

Please report to CDC ill travelers (with symptoms below) arriving from countries in and near the Arabian Peninsula: These countries include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (U.A.E.), and Yemen. 

Please report as soon as possible—before arrival—by one of the methods described in the Guidance for Air Travel Industry on Reporting of Onboard Deaths or Illnesses to CDC. 

Report to CDC if the ill person: 

• feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100° F (37.8° C) or higher, PLUS 

• has a cough or difficulty breathing. 

Please follow your company's policy for personal protection. 

CDC Quarantine Station staff will obtain information about the ill traveler’s exposures and other risk factors for infection with the MERS. If necessary, CDC staff will coordinate transport to a medical facility for evaluation and testing. CDC will update the airline about the results of the testing and any need for follow-up or treatment of exposed crew members or passengers.

Saudi Arabia: 19 kidney patients have contracted MERS.

Saudi Arabia: 19 kidney patients have contracted MERS. HT: Croft.

Via Okaz: 19 injured patients fail to «Corona» in the center of the kidney. The Google translation:

Detection for «Okaz» Director, Center for kidney King Fahd Hospital in Jeddah, Dr. Fouad vermicelli, that about 19 patients with kidney failure have been infected with Corona during the spread at the time and underwent all the isolation and treatment, and the cases in which the evolution of the disease have has been subjected to severe complications did not help treatments Antiviral in saving lives as a result of weak immunity and strength of the virus, which work to destroy the cells of the respiratory tract, noting that this category are likely to have acquired the infection from the emergency, while there have been no new cases during the past two weeks. 

He pointed out that it was the rehabilitation center again after sterilization method, chemical and steam, which included sterilizing all equipment, floors and wards section, pointing out that it has rescheduled washing patients commensurate with the plan sterilization in place in order to avoid the entry of any case bear any viral infection or no symptoms satisfactory similar to «Corona».   

He reported that he is sort of patients before entering the wards hemodialysis through to make sure the temperature of the patient, in addition to requiring all patients to wear a mask medical and so as a precautionary measure, and in the case of a patient complaining of high fever or symptoms similar to Corona, it is converted immediately to an emergency hospital to complete the tests and analyzes necessary.   

He indicated that he was transferred outpatient clinics in the center and earmarked for kidney patients before planting and patients beyond agriculture to the hospital immediately so that their review there in the evening so as to provide an opportunity for patients in the review, according to their circumstances and to relieve pressure on the kidney dialysis center next to break the cycle of the spread of HIV «Corona».   

He suggested that there are about 576 kidney failure patients on dialysis machines and 31 patients on peritoneal dialysis, and there are approximately 1260 patients pre-dialysis follow their examinations and treatment at the center next to 1960 patients have had a kidney transplant.   

D. Vermicelli concluded that the center has stepped up its efforts preventive and awareness during this period in how to avoid exposure to the virus Coruna, in addition to sessions for staff health and educating patients with kidney failure across television screens and to provide guidance for the escorts also from the perspective that an ounce of prevention is worth a pound of cure.

In the early days of this outbreak, patients contracting MERS while in dialysis seemed to be fairly common, but we haven't heard of such cases in a long time until now. The 19 cases appear to be all in King Fahd Hospital. And it's been only two weeks since the last such case?

Foreign doctors, nurses in Saudi Arabia could take MERS global.

Foreign doctors, nurses in Saudi Arabia could take MERS global. (Yahoo).

The biggest risk that Middle East Respiratory Syndrome will become a global epidemic, ironically, may lie with globe-trotting healthcare workers. 

From Houston to Manila, doctors and nurses are recruited for lucrative postings in Saudi Arabia, where MERS was first identified in 2012. Because the kingdom has stepped up hiring of foreign healthcare professionals in the last few years, disease experts said, there is a good chance the MERS virus will hitch a ride on workers as they return home. 

"This is how MERS might spread around the world," said infectious disease expert Dr Amesh Adalja of the University of Pittsburgh Medical Center. 

It can take five to 14 days for someone infected with MERS to show symptoms, more than enough time for a contagious person to fly to the other side of the world without being detectable. Healthcare workers "are at extremely high risk of contracting MERS compared to the general public," Adalja said. 

The threat has attracted new attention with the confirmation of the first two MERS cases in the United States. Both are healthcare workers who fell ill shortly after leaving their work in Saudi hospitals and boarding planes bound west. 

About one-third of the MERS cases treated in hospitals in the Saudi Red Sea city of Jeddah were healthcare workers, according to the World Health Organization. 

Despite the risk, few of the healthcare workers now in, or planning to go to, Saudi Arabia are having second thoughts about working there, according to nurses, doctors and recruiters interviewed by Reuters. 

Michelle Tatro, 28, leaves next week for the kingdom, where she will work as an open-heart-surgery nurse. Tatro, who typically does 13-week stints at hospitals around the United States, said her family had sent her articles about MERS, but she wasn't worried. 

"I was so glad to get this job," she told Reuters. "Travel is my number one passion." 

So far, international health authorities have not publicly expressed concern about the flow of expatriate medical workers to and from Saudi Arabia. 

"There is not much public health authorities or border agents can do,” said infectious disease expert Dr Michael Osterholm of the University of Minnesota. "Sure, they can ask people, ‘did you work in a healthcare facility in Saudi Arabia,’ but if the answer is yes, then what?" 

Healthcare workers are best placed to understand the MERS risk, Osterholm said, and "there should be a heightened awareness among them of possible MERS symptoms."

Related:

Saudi Arabia: Five genera of MERS found in Kingdom

Health authorities reported five more fatalities from the MERS respiratory virus, taking the death toll in the world’s worst-hit country to 168. Nine new cases were reported in the last 24 hours. 

MERS: Updated Charts [& Improved Fatality Data]

WHO: MERS is not yet a PHEIC (Public Health Emergency of International Concern).

WHO: MERS is not yet a PHEIC (Public Health Emergency of International Concern).HT: Croft.

WHO has issued a statement: WHO statement on the Fifth Meeting of the IHR Emergency Committee concerning MERS-CoV. Excerpt:

The fifth meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) concerning Middle East respiratory syndrome coronavirus (MERS-CoV) was held by teleconference on Tuesday, 13 May 2014, from 12:07 to 17:12 Geneva time (CEST). 

In addition to Members of the Emergency Committee, three expert advisors participated in the informational session only1. These advisors did not participate in the formulation of advice to the Director-General. 

Thirteen affected States Parties reporting cases of MERS-CoV or evidence of infection since December 2013, were also on the first part of the teleconference: Egypt, Greece, Jordan, Kuwait, Lebanon, Malaysia, Oman, Philippines, Qatar, Saudi Arabia, United Arab Emirates, United States of America, and Yemen. 

The WHO Secretariat provided an update on and assessment of epidemiological and scientific developments, including a description of the recent increase in cases in communities and in hospitals, transmission patterns, and the main observations of a WHO mission to Saudi Arabia, conducted 28 April – 5 May 2014. 

Affected countries gave information about recent events in their countries, including measures taken and their concerns about the current situation. 

The Members of the Committee discussed the information provided. Based on current information, the Committee indicated that the seriousness of the situation had increased in terms of public health impact, but that there is no evidence of sustained human-to-human transmission. 

As a result of their deliberations, the Committee concluded that the conditions for a Public Health Emergency of International Concern (PHEIC) have not yet been met.

However, the Committee emphasized that its concern about the situation had significantly increased. Their concerns centred on the recent sharp rise in cases; systemic weaknesses in infection prevention and control, as well as gaps in critical information; and possible exportation of cases to especially vulnerable countries.

That last paragraph, in its quiet way, is a devastating indictment of the Gulf monarchies in general and Saudi Arabia in particular.

Very tactfully, WHO is telling them: You don't have MERS under control, your hospitals are dirty and your staff don't know or care about cleaning them, you're not telling WHO or your own people enough, and you're letting people leave your countries when they're carrying the disease.

Related: 

Doctor exposed to MERS virus is in Canada, Florida health officials confirm

First Dutch patient infected with MERS virus

CIDRAP: Florida health workers have symptoms after MERS patient contact

Daily Report.

CIDRAP: Florida health workers have symptoms after MERS patient contact.HT: Croft.

CIDRAP report by Lisa Schnirring: Florida health workers have symptoms after MERS patient contact. Excerpt:

Florida health officials are monitoring two health workers who came down with flulike symptoms after unprotected contact with the second imported US Middle East respiratory syndrome coronavirus (MERS-CoV) patient when he first sought care. 

In addition, amid a flurry of activity with the US infections and cases still rising in Saudi Arabia, with four more reported today, the World Health Organization (WHO) emergency committee on MERS met. The group will announce tomorrow if the latest developments warrant a public health emergency of international concern. 

At a media telebriefing at the Orlando hospital where the MERS patient and one of the health workers are being treated in isolation, health officials also said they are monitoring roughly 100 local people who may have been exposed to the virus. Those being monitored include employees at another Orlando hospital the patient visited while accompanying someone who underwent a medical procedure. 

Though MERS-CoV does not appear to pass easily from person to person in the community, the risk of transmission is much greater in close contact situations, such as when family members or healthcare workers are caring for sick patients. Also, experts have said hospital transmission is magnifying a surge in infections in Saudi Arabia, with mystery still swirling around how the virus is spreading in the facilities. 

Both of the imported US cases are in health workers who live in Saudi Arabia and are employed by hospitals, one in Jeddah and the other in Riyadh.

Related:

US: 20 health workers watched for MERS symptoms

Via InfoTel. News: MERS 101: If you've missed it until now, there's a new disease afoot. 

US: Orlando Hospital statement on second MERS case.

US: Orlando Hospital statement on second MERS case.HT: Croft.

Via Dr. P. Phillips Hospital in Orlando, Florida: Orlando Health Statement on MERS. Excerpt:

Orlando Health’s Dr. P. Phillips Hospital is currently treating a patient who has tested positive for the Middle East Respiratory Syndrome or MERS-CoV. The patient is a 44 year old male who was visiting from Saudi Arabia, where he is a healthcare worker. He is in good condition and is continuing to improve. To ensure patient privacy, that is all the information we can provide about him.   

Physicians believe there is a low risk of the virus being spread by this patient. His symptoms were mild and he did not have a cough when he arrived at the hospital. He had minimal movement around the community prior to being hospitalized. MERS-CoV requires close contact, typically within six feet, for transmission to another person.   

The emergency department at Dr. P. Phillips Hospital is safe for patients, team members, and guests. One of our most pressing goals is to provide accurate information about this virus to individuals who may have been exposed to it, as well as to others in our community. In conjunction with the Florida Department of Health, we are proactively notifying all team members, other patients and their guests who were in this patient’s vicinity prior to his diagnosis of their possible exposure to the virus and the proper precautions to take. Prior to his hospitalization, he accompanied a patient undergoing a medical procedure at Orlando Regional Medical Center. Those team members, patients, and guests are also being notified.   

Precautions may include: 

• Not reporting to work until the incubation period of two to 14 days is over 

• Wearing surgical masks during the incubation period as an added safety measure for family members. 

• Isolating yourself as much as possible during the incubation period. 

• Reporting to the nearest emergency room if you start experiencing symptoms. 

Related:

US: How an Indiana hospital got it right when MERS showed up at the door

Branswell: Expert panel convenes to advise WHO on whether MERS is a public health emergency

Saudi Arabia: Seven new MERS cases, six deaths, as of noon, May 10.

Saudi Arabia: Seven new MERS cases, six deaths, as of noon, May 10. HT: Croft.

Via the KSA MOH English-language MERS page: MOH: '7 New Confirmed Corona Cases Recorded'. The Saudi totals are now 480 cases and 139 deaths.

The total number of the confirmed cases over the past 24 hours: 7 cases 

Recovered and discharged cases that previously tested positive and are now negative: 6 cases 

The total number of deaths: 6 cases (1 case was recorded over the past 24 hours and other 5 cases were previously recorded)   

Overview of the Health Status of the Cases:   

• 2 cases haven’t developed any symptoms 

• 3 stable cases 

• 1 case at the Intensive Care unit 

• 1 death   

Health situation of the cases in detail: 

A. Riyadh:   

1. A 35-year-old man displayed respiratory symptoms on May 8, 2014. He has been in contact with a confirmed case. Now, he is in stable condition. 

2. A 36-year-old man. He has been in contact with a confirmed case and has not developed any symptoms. 

3. A 30-year-old woman. She has been in contact with a confirmed case, and has not developed any symptoms. 

4. A 35-year-old woman suffered from respiratory symptoms on April 28, 2014. She was admitted to a government hospital on May 1, 2014. She passed away on May 9, 2014. May Allah have mercy upon her.   

B. Jeddah: 

1. A 45-year-old man developed respiratory symptoms on May 2, 2014. He was admitted to a private hospital on May 5, 2014. Now, he is receiving IC treatment at government hospital. May Allah grant her a speedy recovery  

2. A 72-year-old woman suffering from diabetes and blood pressure. She suffered from fever, vomiting, and diarrhea on May 3, 2014. She was admitted to a government hospital on May 7, 2014. Now, she is in stable condition.    

C. Makkah: 

1. A 58-year-old woman developed minor respiratory symptoms on April 30, 2014. She has been in contact with a confirmed case. Now, her condition is stable.   

Deaths from previously reported cases:   

1. A 70-year-old man passed away on May 9, 2014.  He was previously recorded as a confirmed case in Jeddah. May Allah have mercy upon him. 

2. A 26-year-old woman passed away on May 9, 2014.  She was previously recorded as a confirmed case in Riyadh. May Allah have mercy upon her. 

3. A 22-year-old man passed away on May 9, 2014.  He was previously recorded as a confirmed case in Riyadh. May Allah have mercy upon him. 

4. A 68-year-old woman passed away on May 10, 2014.  She was previously recorded as a confirmed case in AlMadinah. May Allah have mercy upon her. 

5. A 78-year-old man passed away on May 10, 2014.  He was previously recorded as a confirmed case in AlMadinah. May Allah have mercy upon him. 

Recovered and discharged cases that previously tested positive and are now negative:   

1. A 28-year-old man was discharged from a public hospital in Jeddah. 

2. A 42-year-old man was discharged from a public hospital in AlMadinah. 

3. A 40-year-old woman in Makkah. She was in contact with a confirmed case. Her latest tests were negative for MERS Corona virus. 

4. A 27-year-old woman in Makkah. She was in contact with a confirmed case. Her latest tests were negative for MERS Corona virus. 

5. A 28-year-old woman in Makkah. She was in contact with a confirmed case. Her latest tests were negative for MERS Corona virus. 

6. A 37-year-old woman in Makkah. She was in contact with a confirmed case. Her latest tests were negative for MERS Corona virus.

Related:

Jordan reports 9th MERS case

Canada: Updated MERS travel advisory.

Canada: Updated MERS travel advisory. HT: Croft.

Via the government of Canada: Middle East respiratory syndrome coronavirus (MERS-CoV). Click through for the full updated advisory (still Level 1: Practise usual precautions). Excerpt:

Since April 2012, cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been identified in the following countries in the Middle East: Jordan, Saudi Arabia, Qatar, the United Arab Emirates, Oman, Kuwait and most recently Yemen. 

Cases linked to travel in the Middle East have also been reported in several other countries: France, Italy, Tunisia, the United Kingdom and most recently, in Egypt, Malaysia, Greece and the United States. 

There is growing evidence that direct or indirect contact with camels play a significant role in the virus transmission.  Some of the infections have occurred in clusters between individuals in close contact with one another (e.g. within the same household) and/or an increasing number of infections have occurred among health care workers in health care settings, indicating the importance of following strict infection control practices. This suggests that the virus can spread between humans, however, there has been no sustained person-to-person transmission and the risk of contracting this infection is still considered to be low.

Related:

Thinking about the MERS data (and the lack of it)