Saudi Arabia confirms more MERS cases.

Saudi Arabia confirms more MERS cases.

JEDDAH, SA – Three more confirmed cases of Middle East Respiratory Syndrome (MERS) coronavirus infections in Saudi Arabia have been recorded, the Ministry of Health said on Thursday. 

A statement posted on the ministry’s website said one of the patients is a 67-year-old woman in Riyadh, who had been suffering from various chronic diseases. She is now under intensive care, receiving the health care and proper treatment. The two other cases are both women health workers, one of them living in Asir region and the other in Riyadh. “They have mild symptoms but their health status is stable,” said the MOH. The new cases bring to 92 the total number of people who have contracted the virus worldwide, including 71 in Saudi Arabia.
Of the 92 cases registered with the World Health Organization since last year, 46 have died, including 39 in Saudi Arabia. The latest MERS death in the Kingdom, announced by the Ministry of Health on July 25, was an 83-year-old man in Asir. Saudi and UK scientists studying MERS said the coronavirus is more deadly, unpredictable and has significant differences from severe acute respiratory syndrome (SARS) virus that erupted in Asia in 2003 and infected 8,273 people, nine percent of whom died. Ziad Memish, Saudi deputy minister for public health, earlier said: “MERS coronavirus appears to be more deadly, with 60 percent of patients with co-existing chronic illnesses dying, compared with the one-percent toll of SARS.”

He said that the MERS infecting humans is unpredictable because the source of the virus is not yet known. While sharing clinical similarities with the SARS-like fever, cough and incubation period, he said there are also some important differences such as the rapid progression to respiratory failure of up to five days. The progression occurs earlier than in SARS. In a Lancet Infectious Diseases publication, Saudi and UK scientists also noted a trend of older patients with more men and patients with underlying medical conditions succumbing to the disease. The symptoms of patients suffering from MERS coronavirus are fever (98 percent), chills (87 percent), cough (83 percent), shortness of breath (72 percent), and muscle pain (32 percent). A quarter of patients also experience gastrointestinal symptoms, including diarrhea and vomiting. However, in SARS, the majority of cases (96 percent) occurred in people with underlying chronic medical conditions including diabetes (68 percent), high blood pressure (34 percent), chronic heart disease (28 percent), and chronic renal disease (49 percent).

Read the full story here, Albawaba.

Related: NEJM on person-to-person spread of MERS

Killer coronavirus: Experts link deadly Mers disease to UAE and Qatar.

Killer coronavirus: Experts link deadly Mers disease to UAE and Qatar.(TheNational).

ABU DHABI // A strain of the Sars-like virus that killed an Emirati man has origins in the UAE and Qatar, a report has revealed. The 73-year-old Abu Dhabi man died in a hospital in Germany on March 26, 11 days after developing flu-like symptoms, including a fever and a cough, which turned out to be the Middle East respiratory syndrome coronavirus, or Mers-CoV.

A report by experts published in the Lancet medical journal has now said the man died from a strain similar to that of a Qatari man, who was treated in Germany six months before the Abu Dhabi man.

Stool samples from the Qatari victim had shown he had a “clustering of viruses derived from Qatar and the UAE”, the report said.

Mers-CoV has so far killed 38 people worldwide, most of those in Saudi Arabia, but the Health Authority Abu Dhabi has urged the public to remain calm.

One consultant and head of infectious disease at Mafraq Hospital, Dr Asim Malik, said: “Ever since we first got the reports of the first few cases in Saudi, we have worked in close collaboration with Health Authority Abu Dhabi and Seha.

“It’s not just Mafraq Hospital but all Seha healthcare facilities, namely Sheikh Khalifa Medical City and Tawam.

“We met and developed … guidelines and protocols that were put in place in preparation and anticipation of suspected or confirmed cases of coronavirus.”

The Abu Dhabi victim was first admitted to Mafraq Hospital with suspected pneumonia before he was transferred from the intensive care unit by air ambulance to the Klinikum Schwabing hospital in Munich on March 19.

He died of septic shock seven days later after his kidneys failed and he did not respond to intensive antibiotics and dialysis treatment.

Relatives of the man said he owned camels and had come into contact with a diseased animal shortly before becoming ill. No animal samples could be retrieved, the report said.

Research showed the man had an underlying health condition, having been diagnosed with multiple myeloma, a cancer that affects production of normal blood cells, in 2008.

The report suggested the man had a cancer relapse in November last year and may have had a weaker immune system.

He became the 11th person to die from the virus, which has now claimed 38 lives worldwide, according to the World Health Organisation (WHO).

The report was carried out by doctors and disease experts in research centres in Germany, the US and the UK.

The results of their research paper came as the Saudi Ministry of Health announced an additional four confirmed cases of the virus on Saturday.

The first case is a 43-year-old woman in the country’s eastern region who has recovered. The other three cases are female healthcare workers, aged 29, 39 and 45, who cared for two previously confirmed Mers-CoV cases.

Research has shown that Mers-CoV spreads easily between people, with hospitals, in particular, areas of proliferation.

Worldwide, 68 people have been confirmed as having contracted the virus since September, WHO said. In addition to the UAE, Qatar and Saudi, cases have also been identified in Jordan, Tunisia, the UK, Germany, France and Italy.

The outbreak of the virus has recently prompted Margaret Chan, the director general of WHO, to call it her “greatest concern”.

“The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself,” she said in a speech last month at the 66th World Health Assembly.

“We understand too little about this virus when viewed against the magnitude of its potential threat.”

More than 100 health experts gathered in Cairo, Egypt, at the weekend to discuss what urgent actions are needed at a national level to stem the growing outbreak of Mers-CoV, which belongs to the same family of viruses as the one responsible for Sars, which ultimately triggered a global outbreak that killed about 800 people. WHO yesterday said it is continuing to monitor the situation. Hmmmm.......Qatar and SaudiArabia.Read the full story here.

Killer MERS coronavirus: Eight new MERS PCR Confirmations In Asymptomatic HCWs and Children.

Killer MERS coronavirus: Eight new MERS PCR Confirmations In Asymptomatic HCWs and Children.HT: Recombinomics.

The Ministry of Health that through investigation epidemic disease virus Corona new (MERS-CoV) has been monitoring the virus in four of the contacts of confirmed cases in the areas of Riyadh and the eastern region between the ages of 7 and 15 years old, did not show them any symptoms of the disease, all in good health.

The ministry also announced monitor virus in عاملتين of صحيتين in the eastern region and Hasa and they show no symptoms also,

The above translation from the June 23 Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) update describes six more asymptomatic confirmed MERS-CoV cases.  Two of the cases are health care workers (HCWs) from nosocomial outbreaks in Al Hasa, as well as a second location in the eastern province.  These are in addition to the two asymptomatic HCW cases in Taif, which is in the western region of KSA and adjacent to Mecca (see map).  The asymptomatic cases in Taif are in addition to a mild MCW case and two fatal cases in sisters (65F and 68F) in Taif, signaling a nosocomial outbreak in the west.

In addition, the four confirmed MERS-CoV cases in asymptomatic children who are contacts of cases in Riyadh and the eastern region are the first such cases reported.  The reasons for the dramatic increase in confirmed asymptomatic cases is unclear.

WHO reported the asymptomatic and mild HCW cases in Taif as “weak positives”, which was the terminology used to describe PCR positives in asymptomatic contacts in Italy, which included at least five HCWs  A second lab failed to confirm the weak positives, but different primers were used, raising the possibility that the first set of primers was more sensitive, leading KSA to switch primers.

A NEJM publication of the large nosocomial outbreak in the eastern region described a super spreader and multiple long transmission chains similar to those reported for SARS coronavirus in 2003.  However, the NEJM report also cited 11 probable cases who developed pneumonia and were contacts of confirmed cases but were not confirmed (either because they were not tested or tested negative one time).  The failure to detect MERS included fatal cases that included the index case and the super spreader, signaling serious sensitivities issues.  This may have prompted a change to more sensitive PCR primers and the detection of the asymptomatic cases.

Alternatively, the NEJM paper included full sequences of four of the nosocomial cases generated through a collaboration between the Welcome Trust and the KSA-MoH.  This relationship may have led to sequencing of inserts from PCR tests which proved that the weak positives were true positives, leading to an explosion of confirmed asymptomatic cases which increased the total from 0 to 8 in the past two days. 

As expected these new cases led to a plummet in the case fatality rate for cases with outcomes, which has fallen from 82% (32/39) to 63% (34/54).