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Biological Health Hazard – MERS-COv Disease Outbreak : Saudi Arabia [pilgrimage caution] (Update – 2016-06-23)

2016/06/24

Biological Health Alert – Travel Disease Surveillance

MERS-COV (71): SAUDI ARABIA (MAKKAH), PILGRIMAGE CAUTION, WHO
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Published Date: 2016-06-23 21:37:34
Subject: PRO/AH/EDR> MERS-CoV (71): Saudi Arabia (MK), pilgrimage caution, WHO
Archive Number: 20160623.4305152

In this update:
[1] Saudi Arabia 1 new case, 1 death, 1 recovery
[2] Saudi Arabia – WHO update
[3] UAE caution re: MERS prevention during Umrah and Hajj – media report

******
[1] Saudi Arabia 1 new case, 1 death, 1 recovery
Date: 23 Jun 2016
Source: Saudi MOH 22-23 Jun 2016 [edited]

As of 13:00 [1 PM] today [23 Jun 2016] there have been a total of:
1419 laboratory confirmed cases of MERS-CoV infection including
595 deaths [reported case fatality rate 41.9 percent]
791 recoveries, and
33 currently active cases [including 20 asymptomatic infections]

In the past 48 hours there has been:
1 newly confirmed case
1 newly reported fatality, and
1 newly reported recovery

Information on newly reported case: 23 Jun 2016
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2016-06-23-001.aspx

– A 55 year old Expat (Bangladeshi) male from Jeddah, non-HCW [healthcare worker], currently in stable condition. Classified as a primary case under investigation for contact with camels in the 14 days preceding onset of illness.

Information on newly reported fatality: 23 Jun 2016
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2016-06-23-001.aspx

– An 82 year old Saudi male from Najran, non-HCW with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 18 Jun 2016 at which time he was noted to be in critical condition. Classified as a primary case with no history of contact with camels in the 14 days preceding onset of illness. – Mod.MPP]

Information on newly reported recovery: 22 Jun 2016
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/statistics-2016-06-22-001.aspx

– A 54 year old Saudi male from Alkharj, non-HCW with a history of pre-existing co-morbidities. [reported as a newly confirmed case on 13 Jun 2016 at which time he was noted to be in stable condition. Classified as a primary case with a history of contact with camels in the 14 days preceding onset of illness. – Mod.MPP]

Communicated by:
ProMED-mail
<promed@promedmail.org>

[It seems as though transmission may be picking up in Jeddah while possibly slowed down/interrupted in Riyadh (although it is too early to state definitively, but it has been 3 days with no newly reported infections in Riyadh). This is now the 3rd case reported from Jeddah in the past few days. Today’s (23 Jun 2016) newly reported case in Jeddah has been classified as a primary case with no history of contact with camels. The earlier 2 cases reported from Jeddah on 21 Jun 2016 involved a primary case with high risk exposure to camels under investigation and a household contact (presumably of this case).

A question that begs answering is what are the possible high risk exposures of individuals who are considered primary cases but do not have a history of contact with camels or with other known confirmed cases of MERS-CoV infected individuals.

A map showing the locations of cases and cases with outcomes can be found at the source URL. – Mod.MPP]

******
[2] Saudi Arabia – WHO update
Date: 22 Jun 2016
Source: WHO Emergencies preparedness, response [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia – 22 Jun 2016
————————————————————————————
Between 19 and 20 Jun 2016 the National IHR Focal Point of Saudi Arabia reported 6 additional cases of Middle East Respiratory Syndrome (MERS).

Of the newly reported cases, 4 are associated with the MERS-CoV outbreak occurring in a hospital in Riyadh city, Riyadh region (see DON posted 21 Jun 2016).

Details of the cases:
1- A 34-year-old, non-national, female, working as HCW in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She is asymptomatic and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 20 Jun 2016. The case has no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

2- A 31-year-old, non-national, female, working as HCW in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She is asymptomatic and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 20 Jun 2016. The case has no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

3- A 51-year-old, national, male, living in Taif city, Taif region. He developed symptoms on 15 Jun 2016 and was admitted to hospital on 17 Jun 2016. The patient, who has comorbidities, tested positive for MERS-CoV on 19 Jun 2016. Investigation of history of exposure to the known risk factors in the 14 days prior to onset of symptoms is ongoing. Currently he is in stable condition admitted to a negative pressure isolation room on a ward.

4- A 32-year-old, non-national, female, working as HCW in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She has mild symptoms and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 19 Jun 2016. The case has no comorbidities and no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

5- A 42-year-old, national, male living in Riyadh city, Riyadh region. He developed symptoms on 16 Jun 2016. The patient, who has co-morbidities, tested positive for MERS-CoV on 18 Jun 2016. He is a household contact of a previously reported case (see DON posted 21 Jun 2016, case no.2). He has no other history of exposure to the known risk factors in the 14 days prior to the onset of symptoms. Currently he is in stable condition in home isolation.

6- A 44-year-old, national, male living in Najran city, Najran region. He developed symptoms on 4 Jun 2016 and was admitted to hospital on 16 Jun 2016. The patient, who has no comorbidities but is a smoker, tested positive for MERS-CoV on 18 Jun 2016. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition admitted to the ICU on mechanical ventilation. [reported as a newly confirmed case on 19 Jun 2016 at which time he was noted to be in stable condition. – Mod.MPP]

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 1 MERS-CoV case that was reported in a previous DON on 19 Jun 2016 (case no.1)

Globally, since September 2012, WHO has been notified of 1768 laboratory-confirmed cases of infection with MERS-CoV, including at least 630 related deaths.

Communicated by:
ProMED-mail rapporteur Marianne Hopp

[According to the above WHO update, as of 20 Jun 2016 there have been a total of 1768 laboratory confirmed cases of MERS-CoV infection including 630 deaths reported to WHO since September 2016. Of the 6 newly confirmed cases reported during 19-20 Jun 2016, 4 were associated with the ongoing outbreak in the King Khalid University Hospital in Riyadh – 3 in HCW and the 4th in a household contact of a previously confirmed case. The other 2 cases were classified as 1ary cases, one in Taif, the other in Najran, but investigations on possible high risk exposures were ongoing. Again the question arises as to what are the high risk exposures of primary cases in the event there is a negative history of contact with camels or with other known confirmed cases…

******
[3] UAE caution re: MERS prevention during Umrah and Hajj – media report
Date: 23 Jun 2016
Source: The National [edited]

Health authorities recommended that those travelling to Saudi Arabia should consult their physician 2 weeks beforehand to check their health and pick up advice on how to avoid infection. There have been 34 cases of [MERS-CoV infection] in Saudi Arabia since [15 May 2016], although many of those cases were confined to 1 hospital in Riyadh.

Dr Sawsan Al Nahas, specialist registrar for Dubai Health Authority, said big gatherings such as Umrah and Haj increase the chances of diseases being spread. “Since there isn’t a vaccine for MERS, precautions are very important. To spread, MERS needs very close contact [between the carrier and victim],” said Dr Al Nahas.

She recommended regularly washing hands, using chemical sanitizers, and wearing a mask during rituals in crowded areas. She also said pilgrims should avoid sitting near people who were sick and never to share prayer mats. “The immunity levels of people who have infectious diseases or chronic diseases are low and they can have complications,” she said.

In past years, there have been outbreaks of meningitis, meaning vaccines for this disease are compulsory before travel. Influenza also spreads through coughing and a vaccine is recommended. Diabetics, pregnant women and those who have chronic diseases are most likely to suffer complications, Dr Al Nahas said.

Dr Fatma Al Attar, head of international health regulation at the Ministry of Health and Prevention, said many people required health treatments after falling ill during pilgrimage. She said: “Upper respiratory tract infections, heat exhaustion, injuries, gastroenteritis and pneumonia are the most common health problems affecting pilgrims.”

She was less concerned about the threat from the Zika virus. “Zika isn’t a threat for pilgrims because the mosquito that spreads it is not in the UAE or Saudi Arabia,” she said. Although she added that the possible spread of the disease would be monitored among pilgrims.

“There have been no cases of MERS from Haj and Umrah [in the UAE], but we have to take precautions. Personal hygiene is very important,” Dr Al Attar said. “Because of the awareness campaigns, most people know and they consult family physicians. Advice needs to be tailored and people who have chronic diseases need to ensure they have their medication with them,” she said.

In case someone falls sick during Umrah, they should seek help from doctors in Saudi Arabia. A list of names of doctors will be provided to travelers. Because of the hot weather, pilgrims were also advised to take precautions to avoid heat stroke or dehydration. “Pilgrims should avoid direct sunlight for a long time and use an umbrella whenever possible,” Dr Al Attar said. “They need to remember to drink plenty of water. It’s better if they do hectic activities after sunset because it’s very hot in the day.”

[Byline: Anam Rizvi]

Communicated by:
ProMED-mail
<promed@promedmail.org>

[The above advice of caution for individuals making a pilgrimage to Saudi Arabia in the coming months are prudent precautions. In 2014 and 2015 there were several reports of individuals returning from Umrah with MERS-CoV infection. That being said, given the recent laboratory confirmation of MERS-CoV infection in a resident expat in Abu Dhabi, one wonders what high risk exposures that individual had in the 14 days preceding onset of illness – did that individual travel to Saudi Arabia? Did that individual have contact with camels? Further information is awaited.

The HealthMap/ProMED map of Saudi Arabia can be found at: http://healthmap.org/promed/p/131. – Mod.MPP]

See Also

MERS-CoV (70): Saudi Arabia (MK), UAE, WHO, RFI 20160621.4300452
MERS-CoV (69): Saudi Arabia (MK, RI) 20160620.4299148
MERS-CoV (68): Saudi Arabia (RI, NJ) WHO 20160619.4296553
MERS-CoV (67): Saudi Arabia (NJ,RI) 20160618.4295720
MERS-CoV (66): Saudi Arabia, animal reservoir, camelids, OIE, RFI 20160618.4294807
MERS-CoV (65): Saudi Arabia, RFI 20160617.4294117
MERS-CoV (64): Saudi Arabia (RI) RFI 20160616.4292348
MERS-CoV (63): Saudi Arabia (MD, RI) 20160615.4289697
MERS-CoV (62): Qatar ex Saudi Arabia, additional details 20160614.4287582
MERS-CoV (61): Qatar, Saudi Arabia, RFI 20160613.4284624
MERS-CoV (60): Saudi Arabia (TB) 20160610.4276126
MERS-CoV (59): animal reservoir, review 20160610.4275921
MERS-CoV (58): Saudi Arabia (RI) new case 20160603.4264597
MERS-CoV (57): Saudi Arabia 20160515.4223430
MERS-CoV (56): Qatar, Saudi Arabia, WHO 20160503.4198200
MERS-CoV (55): Bahrain ex Saudi Arabia, Saudi Arabia, WHO 20160425.4182391
MERS-CoV (54): Saudi Arabia 20160423.4179272
MERS-CoV (53): Bahrain ex Saudi Arabia, Saudi Arabia (RI), WHO, RFI 20160416.4163277
MERS-CoV (52): Bahrain ex Saudi Arabia, Saudi Arabia 20160411.4152945
MERS-CoV (51): Bahrain ex Saudi Arabia, Saudi Arabia, RFI 20160410.4150710
MERS-CoV (50): Saudi Arabia (RI, NJ) 20160406.4143365
MERS-CoV (40): Egypt, animal reservoir, camel, ex Sudan, susp. 20160316.4097730
MERS-CoV (30): Saudi Arabia (QS) WHO 20160303.4066494
MERS-CoV (20): Saudi Arabia (NJ, RI) 20160212.4016509
MERS-CoV (10): Saudi Arabia (MK), Thailand ex Oman, RFI 20160125.3964309
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188

2015
—-
MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383

2014
—-
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
—-
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
—-
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
………………………………………….mpp/ao/lm

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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