Spanish MERS case triggers flight contact tracing

European and Spanish health officials released new details today about a Spanish woman who is hospitalized with a Middle East respiratory syndrome coronavirus (MERS-CoV) infection after visiting Hajj holy sites in Saudi Arabia, plus efforts under way to identify those who flew with her from Jeddah to Madrid.

The European Centre for Disease Prevention and Control (ECDC) said today in an updated risk assessment that the 61-year-old woman with no known underlying health conditions was in Saudi Arabia from Oct 2 to Nov 1. She visited Medina, then Mecca and had no known contact with animals.

Her symptoms began Oct 15 with cough and fever, and she was seen at a hospital emergency department of a Mecca hospital on Oct 28 and 29, where health workers diagnosed her as having pneumonia, based on chest x-ray findings.

Spain's health ministry told CIDRAP News that it has relayed more details about the case to European health authorities, including that the woman refused to be hospitalized in Saudi Arabia and was hospitalized in Madrid on Nov 1 when she arrived back in Spain.

According to the ECDC, the patient was sick during the flight and needed oxygen treatment while she was aboard.

The health ministry said she was in Medina from Oct 2 through Oct 10 and in Mecca from Oct 11 through Nov 1.

The patient is still listed in stable condition and has not required intensive care, according to the health ministry.  She was placed in a private room on Nov 1, and her medical team instituted respiratory isolation measures on Nov 4 when they suspected the woman was infected with MERS-CoV.

Initial lab tests for MERS-CoV on three different samples were positive on Nov 5, and further tests are ongoing to confirm the findings, the ECDC said. The health ministry said viral isolation is in progress.

Spanish health officials started contact tracing yesterday, focusing on the woman's family members, healthcare workers, and passengers and airline staff who had close contact with the woman, the ECDC said. It added that no residents from other EU countries were seated within two rows of the patient.

Spain's health ministry said 11 passengers who sat within two rows of the woman have been identified, but information about their resident countries is still pending.

The list of the woman's contacts so far also includes 18 health workers at the Madrid hospital, 7 patients who had contact with her in the emergency department, and 14 family members, including 4 who are under age 5. Spain's health ministry said nasopharyngeal swabs will be obtained from all of the contacts.

In its risk assessment, the ECDC said the detection of another imported case isn't surprising.  "As indicated in previous risk assessments, such cases are to be reported in the EU, and in particular, among pilgrims returning from the Hajj," it said, adding that other European countries have investigated similar cases, but all tests were negative. "This finding confirms the need to pursue efforts to rapidly investigate possible cases."

However, the agency said the detection of the first case in Spain is a reminder of the risk posed by exposure during travel in the Middle East.

The ECDC said the Spanish woman's case is Europe's 10th imported MERS-CoV case and the 13th to be reported outside of the Middle East. The global total is 151 lab-confirmed cases, including 64 deaths.

See also:

Nov 7 ECDC rapid risk assessment

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