Saudi Arabia's health ministry reported five more Middle East respiratory syndrome coronavirus (MERS-CoV) cases over the past 4 days, including one death and what appears to be the first case from a region in the far northern part of the country.
The cases continue the steady dribble of cases from the region, following a surge of cases reported over the spring.
All of the new case-patients are or were middle-aged or older symptomatic men, and none are or were healthcare workers, according to Saudi Ministry of Health (MOH) reports. The illnesses were detected in four different Saudi Arabia locations.
Statements describe fresh cases, one fatal
On Jul 4, the country reported that the virus was detected in a 52-year-old foreigner who is hospitalized in Jeddah and is being treated in an intensive care unit (ICU). The health ministry said the man isn't a healthcare worker and had symptoms before MERS was diagnosed.
Two days later it reported a MERS infection in a 73-year-old man from outside of Saudi Arabia who is hospitalized in Arar, where he is receiving treatment in a critical care unit. Arar, located in Northern Borders province, is about 37 miles from Iraq and is a sheep- and camel-herding area. The health ministry also announced the death of a man with almost the same clinical details, but its statement had conflicting information on preexisting disease for the illness and death reports.
Today the country reported three more infections, all in Saudi residents—two 70-year-olds and one 74-year-old. Two of the patients are hospitalized in Riyadh, one in the emergency department and one in a regular hospital ward. The third patient is hospitalized in Taif, where he is being treated in an ICU.
The new infections lift Saudi Arabia's MERS-CoV total to 720 cases and the newly reported death brings fatalities in the country to 294, according to a tally on the health ministry's main media page.
WHO adds more details for recent cases
In related developments, the World Health Organization (WHO) on Jul 4 announced more details about three MERS-CoV cases initially reported by Saudi Arabia on Jun 30 and Jul 1. All are Saudi citizens. However, it's still unclear how the patients were infected, though two of them had traveled to other parts of Saudi Arabia before they became ill.
One of the patients is a 15-year-old boy from Riyadh who got sick on Jun 26. He was tested at a hospital 2 days later but not admitted. After his sample tested positive for the disease, he was hospitalized and is currently in stable condition. He had recently traveled to Mecca but had not had contact with any previous lab-confirmed cases or exposure to animals or camel products.
The patients reported on Jul 1 include a 53-year-old male pharmacist from the city of Najran on Saudi Arabia's southern coast who got sick Jun 16 and was hospitalized Jun 28; he is listed in stable condition. The ministry's initial report only mentioned that the man was a health worker and that he had an underlying medical condition.
The patient had traveled to the city of Abha in Asir region 20 days before he started having symptoms. He had not been exposed to animals or camel products and, despite his employment in a health-related field, the report didn't say if he had contact with any earlier lab-confirmed cases.
The third case-patient is a 28-year-old housewife from Riyadh who got sick Jun 23 and was hospitalized Jun 29; she is in stable condition. The WHO said the woman didn't have a travel history, contact with a lab-confirmed case, or exposure to animals or camel products before she got sick.
The WHO said investigations into the contacts of the three patients are ongoing.
It also said Saudi Arabia reported another death of an earlier confirmed case-patient, though it wasn't immediately clear which one.
The new cases increase the global total of MERS-CoV cases reported to the WHO to 827 cases, including at least 287 deaths.
Air medical transport guidance
In other developments, the US Centers for Disease Control and Prevention (CDC) on Jul 3 updated its guidance on air transport of MERS patients. It said the recommendations cover only specially equipped aircraft, not commercial passenger planes.
It added that the advisory is designed to protect both the patients and the transport personnel and is based on standard infection control and air medical transport standards, with some specific information from MERS investigations as well as experience gained from handling SARS patients during the 2003 outbreak.
The CDC recommends eye protection to prevent droplet exposure, plus respiratory protection with at least 95% filtering efficiency (eg, an N-95 respirator or higher). It added that whenever possible, MERS patients should be moved on a dedicated flight with the minimum number of crew members and no other non-MERS.
Updated guidance also covers patient placement, other infection control details, mechanical ventilation, managing clinical specimens, waste disposal, cleaning and disinfection, logistics, and in-flight emergencies.
Jul 4 MOH statement
Jul 4 WHO update
Jul 6 MOH statement
Jul 7 MOH statement