Editor's note: This story was revised on May 9 to add Yemen to the list of countries that have had MERS cases.
Lebanon joined the growing list of countries affected by MERS-CoV (Middle East respiratory syndrome coronavirus) with a report of its first case today, while the onslaught of cases in Saudi Arabia continued with 14 more, along with 5 deaths.
Lebanese Health Minister Wael Abu Faour gave few details in announcing the country's first case, saying only that it involved a man who improved with treatment in a hospital and has already been released, according to a report in the Daily Star, a Lebanese newspaper.
Another Lebanese news service, Naharnet, said health ministry officials reported that the patient is a Lebanese national who recently returned from visiting a Persian Gulf country.
Lebanon becomes the 18th country globally and the eighth Middle Eastern nation to report a MERS case. Other affected countries in the region are Saudi Arabia, the United Arab Emirates (UAE), Qatar, Jordan, Oman, Kuwait, Yemen, and Egypt.
Outside the Mideast, cases have been reported in the United Kingdom, Germany, France, Italy, Greece, Tunisia, Malaysia, the Philippines, and the United States. All the cases have been linked directly or indirectly to the Mideast.
Nine cases in Riyadh
In Saudi Arabia, Riyadh and Jeddah, the two leading MERS hot spots, account for 12 of the 14 new cases, with 9 and 3, respectively, according to today's statement from the Ministry of Health (MOH). The other two cases are in Taif and Medina.
One of the newly announced cases, in a 62-year-old woman in Jeddah, was fatal. In addition, four other patients, whose cases were announced previously, have died. Two of them lived in Medina and two in Mecca, the MOH said.
Of the surviving new patients, 2 have no symptoms, 5 are in stable condition, and 6 are in intensive care units, the ministry said. The new cases and deaths raised Saudi Arabia's MERS tally to 463 cases and 126 deaths.
Eight patients, including the one who died, had preexisting chronic illnesses such as diabetes, high blood pressure, or asthma. And at least three patients contracted the illness after being hospitalized for a preexisting illness.
For example, a 63-year-old Jeddah man was hospitalized on Mar 18 because of a tumor, and he experienced respiratory symptoms on May 5, the MOH said. But the statement lists only two patients as having had contact with other MERS patients.
Today's report comes a day after the World Health Organization (WHO) cited infection control deficiencies as a likely factor in the increase in Saudi cases since mid-March. A WHO team reached that conclusion during a 5-day visit to Saudi Arabia, including stops at two Jeddah hospitals.
"The upsurge in cases can be explained by an increase, possibly seasonal, in the number of primary cases amplified by several outbreaks in hospitals due to breaches in WHO's recommended infection prevention and control measures," the agency said. It called for improving health care workers' knowledge and attitudes about the disease and rigorously applying the recommended infection prevention steps.
As has been the case for the past week or more, today's MOH statement did not identify any of the new MERS case-patients as healthcare workers, even though the WHO said yesterday that about a quarter of recent case-patients have been in that occupational group.
US patient keeps improving
In other news, the first US MERS case-patient, a US citizen who recently worked in healthcare in Riyadh, is continuing to improve and is expected to be released to home isolation soon, according to officials at Community Hospital in Munster, Ind., where the man is recovering.
Once released, the man will remain in home isolation until the Indiana State Department of Health and the Centers for Disease Control and Prevention (CDC) determine that he is not infectious, officials said in an e-mailed statement.
Fifty hospital employees who were exposed to the patient are still in their 14-day home isolation period. All have tested negative for MERS-CoV, but they will be tested again at the end of the isolation stint before being allowed to return to work, the statement said.
During an educational teleconference for clinicians this week, a CDC official said it's likely that the United States will see more MERS cases, given the number of travelers between the Arabian Peninsula and the United States.
Marty Cetron, MD, director of the CDC's Division of Global Migration and Quarantine, said that for a risk analysis, his group checked the number of travelers arriving in the United States from the Arabian Peninsula, especially Saudi Arabia and the UAE.
In a 2-month period, more than 100,000 people flew from that region to the US, he said. "So this outbreak is not so far away. This [Indiana case] is the first introduction that we knew of, but it's not likely to be the last," he commented.
Details on Malaysian case
Also today, the Malaysian health ministry published a report in Eurosurveillance on the country's first MERS case, in a 54-year-old Malaysian man who died Apr 13 after returning from a religious pilgrimage to Saudi Arabia.
The report generally confirms information that was provided by the media and the WHO on Apr 16 and 17 but adds more details. It notes that on Mar 26 the man visited a Saudi camel farm, where he petted camels and drank raw camel milk. He arrived home on Mar 29 and started feeling sick on Apr 4. Camels are believed to be a source of human MERS-CoV infections, but the exact transmission route of the virus is unclear.
In an investigation, the health ministry identified 199 people who had had close contact with the man and monitored them for 14 days following their last exposure to him. Seventy-nine people who had some symptoms were tested, with all results negative. No additional cases were found.
The report notes that officials managed to reach 21 of 24 airline passengers who had sat near the man, but the other three, who were not from Malaysia, were hard to track down because "not all airlines have the details of passengers." Officials eventually obtained some information on the three and are now in the process of contacting them, it says.
May 8 Daily Star report on Lebanon case
May 8 Naharnet story
May 8 Saudi MOH statement on 14 cases
May 8 Eurosurveillance report on Malaysian case