WHO praises Saudis on MERS-CoV efforts, cites data gaps

Sunset in Medina, Saudi Arabia
Sunset in Medina, Saudi Arabia

iStockphoto

In the wake of a visit to Saudi Arabia to assess the MERS-CoV situation, the World Health Organization (WHO) praised the Saudis for their response to the virus, but also noted that big gaps persist in the world's understanding of it.

Meanwhile, the US Centers for Disease Control and Prevention (CDC) revealed late last week that a hospital-based cluster of MERS-CoV cases in eastern Saudi Arabia is now numbered at 25, with 14 deaths.

And today the Saudi Ministry of Health (MOH) reported another death involving a person whose MERS-CoV illness was announced earlier. The brief notice said only that the man was a Saudi citizen living in Al-Ahsa governorate and had suffered from chronic kidney failure and other chronic diseases.

The WHO's MERS-CoV case count stands at 55. The latest death in Saudi Arabia raises the fatality count, unofficially, to 32. Saudi Arabia has had 40 cases, including 26 deaths.

The Saudis have been widely criticized for their response to and communication about MERS-CoV, but today's WHO press release about the meeting of Saudi Arabian and WHO officials in Riyadh from Jun 9 to 13 did not mention those concerns.

"The joint mission reviewed the response in KSA [the Kingdom of Saudi Arabia], and concluded that the country has done an excellent job in investigating and controlling the outbreaks," the WHO statement says. It goes on to praise the Saudi government for its hospital infection control efforts, surveillance, public awareness campaigns, reporting to the WHO, and epidemiologic investigations.

"At this point, the right prevention and control measures have been applied, and the KSA government is to be congratulated for urgently taking crucial actions," the statement adds.

But it immediately adds that "large gaps in our knowledge of this virus remain." Those include the original source of the virus, its pathway to humans, how it spreads among humans, the full spectrum of clinical illness, and whether there have been asymptomatic infections.

The WHO praise for Saudi Arabia contrasts with some commentary at the agency's annual meeting, the World Health Assembly, in May. In a speech there, WHO Director-General Margaret Chan, MD, MPH, praised China's handling of the H7N9 influenza outbreaks while emphasizing the need for full and prompt reporting of MERS-CoV cases.

The WHO release explains that three main epidemiologic patterns of MERS-CoV have been observed:

  • Sporadic cases in communities, arising from unknown sources
  • Case clusters in families with probable person-to-person transmission among close contacts
  • Case clusters in healthcare facilities, as seen in Saudi Arabia, France, and Jordan


The CDC, in a health alert notice (HAN) issued late on Jun 7, said the hospital-centered case cluster in the Al-Ahsa region of eastern Saudi Arabia consists of 25 cases with 14 deaths. That's three more cases and four more deaths than mentioned in previous tallies. Some recent Saudi announcements about new cases and deaths in previous cases did not specify whether they were part of the hospital cluster.

The HAN noted that two cases in the cluster were in healthcare workers (HCWs) who caught the virus from patients, a development that was reported previously.

The WHO statement says that MERS-CoV infections in HCWs in Saudi Arabia have been far fewer than might have been expected from the previous experience with SARS (severe acute respiratory syndrome) in 2003, an infection caused by another coronavirus. Cases among HCWs were a big factor in spreading SARS to about 30 countries.

Why HCW cases of MERS-CoV have been relatively few is unclear, but SARS-inspired improvements in infection control may be a factor, the WHO says, adding, "In this context, infection control measures in KSA appear to be effective."

In a separate MERS-CoV update released along with the HAN, the CDC noted that eight case clusters account for 42 of the 55 known MERS-CoV cases so far. Clusters have been reported in France, Italy, Jordan, Tunisia, and the United Kingdom, as well as in Saudi Arabia. The CDC update was an early release from Morbidity and Mortality Weekly Report (MMWR).

Among other points in the MMWR update, the CDC said:

  • As shown in recent cases in Tunisia and the United Kingdom, MERS-CoV cases can be mild
  • Several patients have had gastrointestinal symptoms
  • The median age of patients so far is 56, and all except two were older than 24


On the basis of recent findings, providers should consider a MERS-CoV evaluation for patients who have severe respiratory illness within 14 days of returning from the Arabian Peninsula or neighboring countries, an increase from the 10 days recommended previously, the CDC said.

For diagnostic testing, the agency also recommended that providers collect specimens from different sites, but that the priority should be testing samples from the lower respiratory tract.

In the HAN, the CDC requested that state and local health departments notify it of suspected MERS-CoV cases and clusters of severe acute respiratory infections with no known cause.

See also:

Jun 10 WHO press release

Jun 10 Saudi MOH statement

Jun 7 CDC HAN

Jun 7 MMWR early-release article

May 15 CIDRAP News story covering cases in HCWs

 

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