Saudi Arabia has confirmed two more Middle East respiratory syndrome coronavirus (MERS-CoV) cases, one of them fatal, according to a translated statement from the health ministry today, while media reports said a patient in Qatar has died.
Also today, a Saudi health official said that sequencing of MERS-CoV isolates from an ill Saudi camel and its owner may be completed soon.
The Saudi health ministry said a 73-year-old woman in Riyadh is the latest citizen to die of the illness, according to a machine translation posted on the Avian Flu Diary blog by Michael Coston. It said she had several chronic diseases.
The other new case-patient is a 65-year-old male citizen from the Jawf region, who also has chronic diseases, the statement said. He was taken to Riyadh for treatment in an intensive care unit. No other details were provided. Jawf province is in northern Saudi Arabia and borders Jordan.
The health ministry's MERS-CoV page currently lists 129 cases and 54 deaths in Saudi Arabia.
A death in Qatar
In other developments, one of two recently reported MERS patients in Qatar has died, according to a machine translation of a Kuwait News Agency (KUNA) report today. It said the death involved a 61-year-old man who is a foreign visitor in the country.
The World Health Organization (WHO) said last week that the man was from Qatar and had been exposed to farms with livestock before he got sick on Nov 4.
The KUNA story, citing Qatar's Supreme Council of Health, also said a 48-year-old patient who lives in Doha has recovered and been released from a hospital.
Also today, the WHO released a frequently-asked-questions (FAQ) article on MERS-CoV and a guidance document on how to look for infections in contacts of confirmed case-patients.
In the FAQ piece, the WHO recommends caution in interpreting the recent report from the Saudi health ministry that MERS-CoV was found in a sick camel belonging to a MERS patient. The WHO's view is similar to one expressed yesterday by the World Organization for Animal Health (OIE) discussing the suggestion that camels may be a source of the virus.
"This finding is consistent with previously published reports of MERS-CoV reactive antibodies in camels, and adds another important piece of information to our understanding of MERS-CoV ecology. However, this finding does not necessarily implicate camels directly in the chain of transmission to humans," the WHO said.
It goes on to say that the critical question about the virus is exactly how humans are exposed to it, adding, "Most patients who have tested positive for MERS-CoV had neither a human source of infection nor direct exposure to animals, including camels. It is still unclear whether camels, even if infected with MERS-CoV, play a role in transmission to humans. Further genetic sequencing and epidemiologic data are needed to understand the role, if any, of camels in the transmission of MERS-CoV to humans."
Sequencing results still awaited
Saudi officials have said the MERS-CoV isolates from the camel and its owner are being sequenced to determine if they match. Ziad A. Memish, MD, the country's deputy minister for public health, told CIDRAP News today that he hopes the sequencing will be completed next week.
The WHO FAQ says further that the lack of prior exposure to camels in most MERS cases makes it unlikely that infection occurs through direct exposure to an infected camel. Given the lack of information, the agency says it can't give specific advice on preventing infection, but it advises against contact with obviously sick animals, among other precautions.
The article also notes that human-to-human transmission has occurred in a number of clusters, but no one knows whether the mechanism involves a respiratory route such as coughing and sneezing or direct physical contact.
The guidance document released by the WHO today outlines how to conduct MERS-CoV contact investigations with the aim of determining the spectrum of illness, risk factors associated with infection, and routes and risks of transmission. The 24-page document explains how to find and test all contacts of confirmed and probable case-patients and outlines methods to assess risk factors for infection.
Nov 19 Avian Flu Diary post with Saudi statement on new cases
Nov 19 machine translation of KUNA report on Qatar patients
Nov 19 WHO FAQ article on MERS-CoV
Nov 19 WHO guidance on contact investigations