New Cases of MERS-CoV are Reported to WHO, Including First Cases in Algeria

On June 13, 2014, the National IHR Focal Point of Saudi Arabia notified the World Health Organization (WHO) of  two additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Details of the cases are as follows:

A 36-year-old resident of Almakhwah city, Baha Region became ill on June 4, 2014, was diagnosed with mild pneumonia and was admitted to a hospital on 9 June 2014. The patient is currently in a stable condition. He has underlying medical conditions. He was tested positive to MERS-CoV on June 11, 2014. The patient frequently commutes to Qunfudah city, Qunfudah Region and Wadi Addawaser city, Riyadh Region. The patient has no other travel history. He is reported to have possible contacts with animals as he delivers hay to a mixed animal market. He has no contact with a known laboratory confirmed MERS-CoV case.

A 33-year-old man, a resident of Qunfudah city, Qunfudah Region, is asymptomatic, and was detected through the screening of contacts of previously laboratory-confirmed MERS-CoV cases (reported between April 11 and June 9, 2014). He has no underlying medical condition. He was tested positive to MERS-CoV on 13 June 2014. The patient has a history of frequent travel to Jeddah. He has no history of contact with animals.

Investigation of contacts of the patients and follow-up is ongoing. Additionally, Saudi Arabia has reported an additional 38 deaths among the laboratory-confirmed MERS-CoV cases reported between April 11 and June 9, 2014.

On May 31, 2014, the National IHR Focal Point of Algeria notified WHO of two laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). This is the first report of laboratory-confirmed cases in Algeria. Details of the two cases are as follows:

The first case is a 66-year-old man who was part of a pilgrimage group that went to Saudi Arabia to perform Umrah on May 14, 2014. The patient became ill on May 23, 2014, while in Saudi Arabia. Upon his arrival to Algeria on May 28, 2014, he was hospitalized. The patient has underlying medical conditions.

The second case is a 59-year-old man who went on a pilgrimage in Saudi Arabia on May 5, 2014. The patient became ill on May 23, 2014, while in Saudi Arabia. On May 29, 2014, he was hospitalized. He did not have any underlying medical condition. Despite all medical care, the patient died on June 10, 2014 from multi-organ failure.

Since June 2013, the Ministry of Health, Population and Hospital Reform (MSPRH) has enhanced activities for the early detection and monitoring of MERS-CoV. MSPRH was alerted by the Prefecture Health Services of Tipaza and Tlemcen of the two suspected cases of MERS-CoV on May 29, 2014. On May 30, 2014, laboratory confirmation was established for both cases by the Institut Pasteur in Algeria.

Medical and preventive measures have been implemented in accordance with the instructions issued by MSPRH, which include: meetings of the crisis committee; points of entries have been informed to heighten surveillance, and inform passengers traveling to pilgrim areas. Information products have been developed and are distributed to passengers. A special area has been assigned to facilitate interaction with passengers, the distribution of leaflets with public health recommendations, as well as the distribution of disinfectant and masks; investigative teams are following up on confirmed and suspected MERS-CoV cases based on national directives for surveillance and alert; and
information campaigns are ongoing, using different channels of information including the media.
 
The National IHR Focal Points of Saudi Arabia, the United Arab Emirates (UAE) and the Islamic Republic of Iran recently reported additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) to WHO. Details of the cases reported by Saudi Arabia are as follows:

Between April 11 and June 9, 2014, 515 cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported from Saudi Arabia to WHO. This includes 402 laboratory-confirmed cases reported on various dates, and 113 cases that have been identified through retrospective review of hospital records, and which was reported by Saudi Arabia on June 3. Further information on these cases will be provided as information becomes available as part of the collaboration between the Saudi authorities and WHO on the MERS-CoV response.

This update covers 402 laboratory-confirmed cases, including 114 deaths. Thirty-five cases were reported from Madina, 132 from Riyadh, 208 from Mecca Province (including 154 from Jeddah, 39 from Mecca, 8 from Qunfudhah and 7 from Al Taif), 10 from Tabuk, 6 from Al Jawf, 3 from Najran, and 3 from Ash Sharqiyah. The location from where 5 cases were reported was not specified.

The median age of the 402 cases is 46 years old (ranging from 9 months to 94 years old) and 58.3% of those with information on sex (n=388) are men. Almost half (44.5%) of the cases with reported information (n=398) experienced severe disease including 114 cases who died; and 114 cases (28.6%) were reported to be asymptomatic or have mild disease. Underlying medical conditions were only reported for 149 of the 402 cases, of which 140 cases were reported to have at least one underlying medical condition.

More than 25% (109)of the 402 reported cases are health care workers. Among the 109 health care workers, 63 were reported as asymptomatic or developing mild symptoms, 35 were reported with moderate symptoms (requiring hospitalization but not admission to an intensive care unit), 7 were reported as having severe disease and 4 died.

Details of the case reported by the UAE on June 4, 2014 are as follows: The patient is a 36-year-old butcher residing in Abu Dhabi. He works in a local slaughterhouse for camels and sheep. He was asymptomatic. His sputum was tested positive for MERS-CoV on May 20, 2014 as part of a general screening in slaughterhouses. The patient had no contact with a previously laboratory-confirmed MERS-CoV case. He had no history of travel. The patient is currently isolated and is in a stable condition. Investigations and follow up of contacts of the patient have been carried out and no other case was detected.

Details of the case reported by the Islamic Republic of Iran on June 4, 2014 are as follows: The patient is a 35-year-old nurse assistant. She developed a mild illness on 26 May 2014 followed by a productive cough on May 28, 2014. Her throat swab taken on May 26, 2014 was tested positive for MERS-CoV. She has been advised to stay home and follow infection control precautions. The patient is a close contact to the first laboratory-confirmed MERS-CoV case in the country reported to WHO on May 26, 2014. The patient did not have an underlying medical condition. She had no history of contact with animals and no history of consumption of raw camel products in the 14 days prior to becoming ill. She became asymptomatic on 3 June 2014 and her condition is currently stable. Investigations into her contacts among healthcare workers and family members is ongoing.

Globally, 701 laboratory-confirmed cases of infection with MERS-CoV, including at least 249 related deaths have officially been reported to WHO.

Source: WHO