The tally of MERS-CoV (Middle East respiratory syndrome coronavirus) cases inched upward today with reports of two more cases in Saudi Arabia and one in Jordan, while questions and speculation continued over yesterday's Saudi revelation of scores of previously unreported cases and deaths.
The latest cases in Saudi Arabia involve a 28-year-old woman who is hospitalized in Al Jawf and a 45-year-old man in an intensive care unit in Dhahran, the Saudi Ministry of Health (MOH) reported. It said the woman is an expatriate healthcare worker, while the man is a Saudi and not a health worker.
Al Jawf is in the northwestern part of the country, while Dhahran is on the Persian Gulf coast in the Eastern province. Although the MOH's new reporting format offers a little more information than the old one, it doesn't include information about how patients were exposed to the virus.
The ministry also reported a death in a previously reported MERS case, that of a 66-year-old expatriate in Medina. He was not a health worker.
The new cases raise Saudi Arabia's MERS count to 691 cases with 284 deaths, which means the case-fatality ratio is 41%.
Case in Jordan
The latest Jordanian case was reported by the World Health Organization (WHO). It involves a 26-year-old healthcare worker who got sick after having contact with another health worker who was a MERS patient, the agency said.
The man fell ill with a fever on May 23, and he was hospitalized with pneumonia and gastrointestinal problems on May 30. He is in stable condition, the WHO said. He has no preexisting illnesses and no history of recent travel or contact with animals. Six family members and 54 other contacts of the patient are being screened for MERS-CoV.
The new case appears to be Jordan's 17th confirmed one, on the basis of a May 31 report by the European Centre for Disease Prevention and Control that put Jordan's MERS count at 16 cases and 4 deaths.
The case raises the WHO's MERS tally to 681 cases and 204 deaths. The agency said the number includes 44 cases that Saudi Arabia reported between May 19 and Jun 2, adding that it is working with the government to obtain more information on those cases.
More on previously undisclosed Saudi cases
Meanwhile, questions remained today about the Saudi government's disclosure yesterday of 113 previously unreported MERS cases and 92 deaths. Most of the cases occurred during the surge that started in late March and continued until early May.
The MOH said the cases were uncovered through a careful review of all its MERS-CoV data, but it didn't explain why they weren't reported earlier or how they were detected or confirmed. The agency did not publish any new information about them today.
The WHO is looking into the added cases, with a team in Saudi Arabia going through the data on each of them, the Canadian Press (CP) reported today.
Stephane Hugonnet, the WHO's technical lead for MERS, said the agency regards the Saudi review of its data as a positive step, but the agency is uncertain whether all the newly identified cases will fit the WHO's MERS case definition, according to the story.
Hugonnet also said it does not appear that the additional cases were found through retesting of stored samples.
Allsion McGeer, MD, a Toronto expert who helped investigate a MERS outbreak in a Saudi hospital in 2013, said it's difficult to fathom why the Saudi cases were not reported earlier and noted that many factors may be involved. A microbiologist and infectious disease consultant at Toronto's Mt. Sinai Hospital, McGeer was a leader in the city's response to the SARS outbreak in 2003.
She told CIDRAP News that until recently, all MERS-CoV testing in Saudi Arabia was done in public health reference laboratories, but she believes that in recent weeks, large hospitals have started doing their own testing.
"One of the potential explanations [of the missed cases] is that in the course of moving testing from reference labs to the hospitals labs, there were some failures in surveillance," she suggested.
McGeer also commented that the numbers of cases and deaths that Saudi Arabia announced yesterday are not large enough to fundamentally change the current understanding of the MERS-CoV threat.
"I don't think anyone looking at the graph [in yesterday's Saudi statement] says it is changing the risk to countries outside Saudi Arabia," she said. "I don't think it alters anything. Even retrospectively, I don't think it alters what people would've done at the time," had they known about the additional cases.
The current Saudi case-fatality ratio of 41% is up from its previous level of about 33%, but McGeer said that change is "not enough to change the course of what people are doing." She said the previous ratio was already high enough to warrant "a full-court press to figure things out."
See also:
Saudi MOH statement on 2 new cases
Saudi MOH MERS-CoV page with case count
Jun 4 WHO statement on Jordan case
Jun 4 CP story
