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SASTM Newsflash - MERS-COV, Eastern mediterranean: Saudi Arabia,WHO


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SASTM Newsflash






MERS-CoV - update 23 Jun 2013


The Ministry of Health (MoH) in Saudi Arabia has announced 2 additional laboratory-confirmed cases and a death in a previously confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV).


One case is a 41-year-old female from Riyadh who had contact with a confirmed case. The other case is a 32-year-old male from the Eastern Region with underlying medical conditions who is in critical condition.


In addition, the MoH has announced the death of a previously reported confirmed case from the Eastern Region who had been admitted to hospital on [26 Apr 2013] [according to the Arabic page of the Saudi MOH press release (in Arabic), this was an 81-year-old male.


Globally, from September 2012 to date, WHO has been informed of a total of 70 laboratory-confirmed cases of infection with MERS-CoV, including 39 deaths.


WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Italy, Tunisia, and the United Kingdom also reported laboratory-confirmed cases; they were either transferred there for care of the disease or returned from the Middle East and subsequently became ill. In France, Italy, Tunisia, and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.


Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.


Healthcare providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients' lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhoea, in patients who are immunocompromised.


Healthcare facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Healthcare facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, healthcare workers and visitors.


All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.


WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.


WHO continues to closely monitor the situation.


[As of 23 Jun 2013, when this global update was released, there were a total of 70 laboratory confirmed cases of MERS-CoV infection including 39 deaths reported to WHO. This tally does not include the additional cases reported on the Saudi MOH website later on in the day on 23 Jun 2013


Saudi Arabia: 7 additional laboratory confirmations, 1 death MOH


MOH announces recovery of contacts of novel coronavirus cases and one [death] in the Eastern Region


Within the framework of the epidemiological surveillance of the novel coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that 4 cases of this virus have been recorded among people [with contact with] confirmed infected patients in Riyadh and the Eastern Region, ranging in ages between 7 and 15 [years]. It is noteworthy that the disease symptoms were not shown in their cases and their health condition is good.


Furthermore, MOH has announced that 2 cases of this virus have been recorded among female health workers in the Eastern Region and Al-Ahsa. Also, the disease symptoms were not shown in their cases [asymptomatic]. That is to be added to another 50-year-old female case recorded in the Eastern Region. Currently, she is hospitalized due to pulmonary disease but her health status is stable.


Thus, the total number of confirmed cases, who didn't show disease symptoms or completely recovered is 20.


The MOH has announced the death of one case, aged 32, in the Eastern Region, who had been previously announced to be infected with this virus and had been suffering from cancer.


[According to the Saudi MOH summary page on coronavirus there are now 62 laboratory confirmed cases of MERS-CoV infection, including 34 deaths in Saudi Arabia, representing an increase of 7 cases and one death. The addition of these cases will also raise the global case count -- if the asymptomatic infections in case contacts are included in the global case count, it will raise the global total to 77 cases including 40 deaths.


MERS-CoV: reporting recommendations


MERS-CoV challenges


Recommendation for MERS-CoV posts: the test method should be included in all posts identifying cases. With the exception of Saudi Arabia's 1st case, which was diagnosed by Dr Ali Zaki using classical viral culture methods, all subsequent cases have been diagnosed by experimental molecular amplification tests (PCR [polymerase chain reaction] or NAAT [nucleic acid amplification] tests). A handful have also been accompanied by positive virus isolations. Therefore posts announcing 'positive' and 'negative' cases, identified only by molecular testing, should be reported as 'PCR-positive' or 'PCR-negative'. It would also be helpful if the genomic target for the molecular test were included. Isolation of the MERS virus might also be included to reinforce the specificity of the molecular test in use. It is still the case that no clinical validation studies have been published on any commercially available molecular tests and it will take time for them to be cleared by regulatory authority. It is also true that molecular tests for MERS-CoV appear to have limitations very similar to what we in Canada experienced with SARS-CoV molecular tests, that is, low sensitivity and poor negative predictive values. This bias causes problems evaluating case rates which tend to be under-reported and fatality rates which are spuriously elevated. Once serologic reporting is available, cases that are 'seropositive' or 'seronegative' should be so identified. As many of these tests will be based on proprietary recombinant assays, readers should be informed that these are experimental assays unless validation details are included or otherwise published. During the SARS outbreak in Canada, classic, non-proprietary neutralization tests performed well, and eventually helped establish the accuracy of both recombinant serologic assays and molecular detection tests.


Communicated by: ProMed mail



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The information provided in SASTM Newsflashes is collected from various news sources, health agencies and government agencies. Although the information is believed to be accurate, any express or implied warranty as to its suitability for any purpose is categorically disclaimed. In particular, this information should not be construed to serve as medical advice for any individual. The health information provided is general in nature, and may not be appropriate for all persons. Medical advice may vary because of individual differences in such factors as health risks, current medical conditions and treatment, allergies, pregnancy and breast feeding, etc. In addition, global health risks are constantly evolving and changing. International travelers should consult a qualified physician for medical advice prior to departure.

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