Lapses in hospital infection infection-control practices appear to be magnifying Saudi Arabia's recent steep rise in Middle East respiratory syndrome coronavirus (MERS-CoV) infections, according to an expert team from the World Health Organization (WHO) that just completed a visit to the country that included two hospitals.
And, signaling a continuing surge of new cases, Saudi Arabia's health ministry today reported 28 more cases and 6 more deaths.
Mission report findings
The WHO said in a statement today that its team just completed a 5-day mission to Saudi Arabia to explore the reasons for the recent gush of cases. In late April the WHO offered its assistance, and Saudi health officials invited the expert team to visit.
The experts met with health officials in Riyadh to explore the epidemiologic, disease prevention, organizational, and communication components of the outbreak to better gauge the public health risk and to suggest the next steps for curbing the disease.
Afterward, the team visited two of Jeddah's main hospitals to investigate transmission patterns and review infection control practices. Hospital-based outbreaks in both Jeddah and Riyadh have made up a large part of the recent surge, and dozens of healthcare workers are among the reported cases.
So far there's no evidence to suggest the spike in cases reflects a significant change in virus transmissibility, one of a handful of possibilities that health officials had proposed. The experts said the increase could have resulted from a seasonal increase in primary cases that was amplified by hospital outbreaks, due to breaches in the WHO's recommended prevention and control measures.
"There is no evidence of sustained human-to-human transmission in the community, and the transmission pattern overall remained unchanged," the group said, adding that most of the human-to-human infections are occurring in health facilities and that a quarter of the cases have been in healthcare workers. The experts emphasized that there is a clear need to teach health workers about MERS and how to apply recommended infection control measures.
The reasons behind the increase in primary community cases and the infection route are still unclear, the team said. They noted that three quarters of the MERS cases in the community have involved men over age 50.
Saudi Arabia reports 28 more cases, six deaths
The country's ministry of health (MOH), meanwhile, released details about the new cases in two statements. Most of the illnesses were reported from the main outbreak areas, including Jeddah (10), Riyadh (9), Medina (5), and Mecca (2), but the statements also describe a case in Taif, not far from Mecca, and from Najran, a city in southwestern Saudi Arabia near the Yemen border.
Eleven of the patients are hospitalized in intensive care units (ICUs), six are listed in stable condition, and 10 are asymptomatic. One of the patients died, a 65-year-old woman from Riyadh who had underlying health conditions.
Fourteen of the patients had been in contact with a previously confirmed case-patient. The reports, though, did not say if any were healthcare workers. No exposure to camels or animal environments was listed for any of the patients.
Illness onsets were listed for 15 people and range from Apr 5 through May 5. The ministry included hospitalization dates for 14 patients, which range from Apr 28 through May 5.
All of the patients are adults, except a 10-year-old boy who got sick with respiratory symptoms after an earlier hospitalization following an accident. Among the adults, patient ages range from 26 to 84, though most were younger or middle-aged. Fifteen of the 28 patients are male.
The MOH said 5 more previously reported case-patients have died, 3 from Jeddah, 1 from Riyadh, and 1 from Medina.
The new cases and deaths boost Saudi Arabia's total from the disease to 449 cases, 121 of them fatal.
Details on Jordanian, Yemeni patients
In other news, the WHO today released two statements that filled in some details about MERS cases in two Jordanians and a Yemeni, all of which were reported previously by the news media.
The Jordanian cases involve a 28-year-old healthcare worker who is in stable condition and a 56-year-old respiratory therapist who died on Mar 31, the WHO said. The younger man fell ill on Apr 22, but a chest x-ray and MERS-CoV test on Apr 26 and 27 yielded normal findings. On Apr 30 he experienced a cough and fever and was hospitalized in Zarka, and he tested positive on May 2.
The patient had contact with a previously reported case-patient who was also hospitalized in Zarka, the WHO said.
The 56-year-old man, who lived in Zarka and worked at a private clinic, was hospitalized with pneumonia on Apr 28, the agency said. He was placed in an ICU on May 3 and tested positive on the 5th, the day he died. He had no recent travel history or exposure to other MERS patients, the WHO reported.
The Yemeni patient, a 44-year-old man, fell ill on Mar 17 and died in a Sanaa hospital on Mar 31, the WHO said. News services reported his case on Apr 14, describing him as Yemen's first MERS victim. The WHO indicated that a lab in Yemen confirmed MERS-CoV in the patient on Apr 2, and the diagnosis was later confirmed by US Naval Medical Research Unit-3 (NAMRU-3).
The man was an aircraft maintenance engineer who had contact with passengers at the airport where he worked, but he had no history of recent travel and no known contact with another MERS patient. However, he was reported to have visited a camel farm weekly and drunk raw camel milk, the WHO said.
May 7 WHO statement on Saudi Arabia expert mission
May 7 Saudi MOH statement on 10 cases
May 7 Saudi MOH statement on 18 cases
Saudi MOH MERS page with case count
May 7 WHO statement on Jordan cases
May 7 WHO statement on Yemen case