MERS arrives in Algeria, hits 6 more in Saudi Arabia

MERS-CoV (Middle East respiratory syndrome coronavirus) arrived in Algeria in the form of cases in two men who had gone on an Umrah pilgrimage to Saudi Arabia, the World Health Organization (WHO) announced on May 31.

In addition, six more MERS cases were reported in Saudi Arabia today and over the weekend. And today, the Saudi Ministry of Health (MOH) tersely announced the firing of Deputy Health Minister Ziad Memish, MD, who long served as the government's lead spokesman on MERS and was often the target of criticism about the MOH's response to the disease.

In another MERS development, the European Centre for Disease Prevention and Control (ECDC) released a new MERS risk assessment on May 31, saying the risk for Europe remains low but that more cases will probably be imported to Europe from the Arabian Peninsula.

Algerian cases

The WHO's Regional Office for Africa said the two Algerian cases involved a 66-year-old man and a 59-year-old man who were in Saudi Arabia for the Umrah pilgrimage, but it did not indicate that the two traveled together.

The 66-year-old sought care for fever and dyspnea after arriving in Algeria from Mecca on May 23, and was hospitalized, the WHO said. The younger man got sick with an influenza-like illness and diarrhea in Saudi Arabia on May 23. He was hospitalized in a different Algerian hospital May 29.

The diagnosis of MERS-CoV was established for both men on May 30, the statement said. It gave no information about their conditions, their possible exposures in Saudi Arabia, or monitoring of their contacts.

Algeria is the 21st country to report a MERS case. The 20th was Iran, which reported two cases last week in women who had gone on a pilgrimage to Saudi Arabia. All cases so far have had direct or indirect links to countries on or near the Arabian Peninsula.

The WHO said the "early detection" of the two Algerian cases resulted from "intense preparedness activities implemented over the past months by the Ministry of Health, Population and Hospital Reform of Algeria in close collaboration with WHO and partners."

Latest Saudi cases

The Saudi Arabian MOH reported 1 case each on May 31 and Jun 1 and 4 more cases today. They include 2 cases in Medina and 1 each in Jeddah, Al Jawf, Mecca, and Qunfudhah (also spelled Gonfodah).

Five of the patients are men, and the ages range from 31 to 57. Just one patient, a 31-year-old man in Medina, had contact with another MERS patient before getting sick, the MOH said.

The patient who died was a 42-year-old man in Al Jawf. Of the other five patients, three were in stable condition and two in critical condition, the MOH said.

Yesterday the ministry reported two deaths in previously announced cases, involving a 55-year-old man in Riyadh and a 45-year-old woman in Jeddah.

Also today, a MERS death was reported in Jordan. Arab News reported that a 69-year-old man who had diabetes and hypertension died on May 28, 5 days after he was hospitalized. The story said his demise raised Jordan's MERS death toll to six.

Sacking of Memish

Word of the firing of Memish came in a very brief announcement in Arabic on the Suadi MOH Web site today.

A computer translation of the statement, posted on Avian Flu Diary, an infectious disease blog, cited "a decision to release" Memish from his office, without giving a reason.

As noted by Avian Flu Diary, Memish has been an author of many research papers on MERS-CoV. He has also been criticized over the Saudi response to the disease, especially the generally sparse sharing of information about cases. The flow of information has improved somewhat since Adel bin Mohammad Faqih was named minister of health on Apr 21.

The lack of case-control studies in Saudi Arabia to help pinpoint the source of MERS-CoV infections has often been decried by experts.

Memish has defended his country's response to MERS-CoV on a number of occasions. Last week, for example, Reuters reported that he said he was "surprised" by allegations from scientists that Saudi officials had rejected offers of help in dealing with the disease.

Memish told Reuters that the government had been "nothing but collaborative," and he promised to continue involving more international partners, according to the story.

ECDC risk assessment

In its latest MERS risk assessment, the ECDC generally echoed its previous judgment in late April that the risk for cases in Europe is low but that more cases are likely to be imported from the Middle East.

"Currently, the risk of human infections and sustainable human-to-human transmission in Europe remains low," the agency said. But because of the increase in cases in the Middle East this spring and high volume of travel between that region and Europe, "it is likely that more cases will be imported and detected" in Europe.

The ECDC also said it is unlikely that the recent surge of cases can be explained either by viral mutations or by false-negative test results. But three other factors, it said, are probably playing a part in the increase:

  • Increased transmission from animals
  • Suboptimal infection control in hospitals (a conclusion that echoes what the WHO said on May 7)
  • "A more sensitive case-detection algorithm used in some areas"

The ECDC also commented, "In addition, there is an increasing body of evidence that dromedary camels are the direct or indirect source of infection for many of the human cases."

 See also:

May 31 WHO Africa statement on Algeria cases

Jun 2 Saudi MOH statement

Jun 1 Saudi MOH statement

May 31 Saudi MOH statement

Jun 2 Arab News story

Jun 2 MOH Arabic statement on Memish firing

Jun 2 Avian Flu Diary post on Memish

May 29 Reuters story quoting Memish

ECDC's 10th risk assessment for MERS-CoV

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