MERS reaches Netherlands; 2 Florida patients cleared

The Netherlands reported its first case of MERS-CoV (Middle East respiratory syndrome coronavirus) today, while Saudi Arabia announced 16 more cases, and two Floridians who had flu-like symptoms after exposure to the second US MERS patient tested negative for the virus.

Also today, US health officials said four people who shared an airline flight from the United Kingdom to Chicago with the nation's first MERS patient reported mild symptoms, but no cases have been found among the man's fellow travelers.

Dutch patient was in Saudi Arabia

A Reuters report today said a man who returned from Saudi Arabia to the Netherlands has been hospitalized with a MERS-CoV infection in The Hague. The story gave no other details about the patient or his illness.

A machine-translated statement from the Dutch National Institute for Public Health and the Environment, however, said the man is in stable condition and that all his contacts have been identified and are being monitored. The statement was posted on Avian Flu Diary, an infectious disease blog.

The case makes the Netherlands the 19th country to report a MERS infection. All cases in countries outside the Middle East have been linked directly or indirectly to that region. Other European nations that have had cases are the United Kingdom, Germany, France, Italy, and Greece.

Florida patients test negative

Meanwhile, two Florida healthcare workers who experienced flu-like symptoms after having unprotected contact with the United States' second MERS-CoV patient have tested negative for the virus, an official at Dr. P. Phillips Hospital in Orlando said in an e-mailed statement today.

One of the two hospital staff members was hospitalized on May 12, and the other was discharged the same day, according to Katie Dagenais, MA, the hospital's media relations manager.

Yesterday hospital officials said the two workers had been exposed to the MERS patient before his infection was suspected. One of them got sick just 24 hours after exposure, and the other had symptoms 72 hours after exposure.

Test results were still awaited for 18 other health workers at the hospital, Dagenais said.

The MERS patient, who is in isolation at the hospital, has been fever-free for 24 hour and is doing well, Dagenais reported. He is a 44-year-old health professional who lives in Jeddah, Saudi Arabia, and works at a hospital in the city, which is the country's top MERS hot spot. The man had mild symptoms when he flew to the United States on May 1 and was hospitalized on May 9.

The man's case was announced May 12, 10 days after the first US MERS case was reported in a male healthcare worker who is a US citizen but had been working in a Riyadh hospital before flying to the United States to visit relatives. He was hospitalized in Indiana but was released this week.

US contact investigations

In related news, the US Centers for Disease Control and Prevention (CDC) reported a few new details about the first two US MERS cases in an article today in Morbidity and Mortality Weekly Report (MMWR).

Concerning the first case, the agency said it contacted 58 of 80 passengers and all 12 crew members who were on the man's flight from the United Kingdom to Chicago. None of the crew reported any symptoms. Four passengers reported mild symptoms that did not meet the criteria for a suspected MERS case, but the patients were closely monitored for the 14-day MERS incubation period.

In addition, 5 of 9 passengers and the driver on the bus that the patient rode from Chicago to Indiana were contacted, and none reported any symptoms, the CDC said. Also, all the patient's household, community, and health-worker contacts have tested negative for MERS-CoV.

As for the Florida patient, the CDC and state and local health officials are currently working to find and notify airline passengers who shared flights with him, the report said.

In other observations, the report said that 19% (104) of the 536 MERS case-patients identified by the WHO as of May 12 were healthcare workers. Five percent (32) of the patients had mild symptoms or did not need hospitalization, and 21% (110) had no symptoms, the CDC said.

Also today, a hospital official in Orlando said an Orlando doctor who was exposed to MERS-CoV flew to Canada before knowing he might be at risk, according to a CTV News report. Efforts are being made to test the doctor for the virus, Geo Morales, a spokesman for Orlando Health, reported. He said the doctor is still in Canada.

Two deaths among 16 new Saudi cases

In Saudi Arabia, health officials today announced 16 more MERS cases, 2 of them fatal. Six of the patients are in intensive care units (ICUs), five are in stable condition, and three have no symptoms, the country's Ministry of Health (MOH) reported. The fatalities involved two women in their 60s, both in Riyadh.

Nine of the new cases are in Riyadh, five are in Jeddah, and two are in Medina. The patients' ages range from 2 to 72 years, and 12 of them are female.

Three patients had contact with other MERS case-patients, the MOH said. Details in three other cases suggest that the patients caught the virus while hospitalized for treatment of other conditions. As has been its recent practice, the ministry didn't say whether any of the patients are health workers, although many of them are of working age.

The 2-year-old child who was infected has congenital anomalies, the MOH said. She became ill on Apr 19—the earliest onset date for any of the newly reported illnesses—and is in an ICU.

The ministry also said three other patients with previously reported cases have died.

Meanwhile, the Saudi Gazette reported today that two doctors in Jeddah were among the recent MERS fatalities in Saudi Arabia. It identified them as Tarek Waleed Rajikhan, a dermatologist at King Fahd Hospital, and Ahmed Al-Ghuniam, who was working at an unnamed private hospital in the city.

And in still another development, the MOH yesterday announced a package of measures aiming to control MERS-CoV, according to a computer-translated statement posted on Avian Flu Diary.

As outlined in the statement, the measures are:

  • Issuance of strict infection control guidelines
  • The appointment of a task force to mount a rapid response to MERs-CoV cases around the country
  • A review of the readiness of major hospitals to deal with MERS cases
  • A comprehensive audit of the number of MERS cases detected in all healthcare facilities since the virus first emerged

See also:

May 14 Reuters story on Dutch case

May 14 Florida Department of Health update on Florida case

May 14 MMWR article

May 14 Saudi MOH statement on 16 cases

May 13 Avian Flu Diary post on Saudi MOH announcement about control measures

May 14 CTV News story about doctor in Canada

May 14 Saudi Gazette story about two doctors who died

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