MERS cases from Riyadh still surging

Saudi Arabia's health ministry announced 20 new MERS-CoV cases over the past 3 days, all but 1 of them in Riyadh, and it said yesterday that so far 53 recent infections from the city have been linked to King Abdulaziz Medical Center.

In related developments, Philippine authorities said today that four Filipino nurses who work at the hospital are among the infected, with two of them receiving treatment in the intensive care unit (ICU), and the World Health Organization (WHO) recently fleshed out clinical details for several of the recent MERS-CoV (Middle East respiratory syndrome coronavirus) cases reported in Saudi Arabia.

The surge of cases reported over the past 3 days vaults Saudi Arabia's total in the Riyadh outbreak—much of it linked to the hospital—since Jul 21 to 100 cases.

Newest confirmed cases

The Saudi Ministry of Health (MOH) reported 7 cases on Aug 22, 6 yesterday, and 7 today. Over the 3-day period the country also reported six deaths, all of them in Riyadh. Of the 20 new cases, 14 had contact with a suspected or confirmed MERS-CoV case in the community or in a hospital.

The only patient who isn't from Riyadh is a 67-year-old Saudi man from Alzulfi, a city located about 160 miles northwest of Riyadh. He is in stable condition, and the man had no known contact with a suspected or confirmed case.

Fifteen of the latest confirmations involve Saudi citizens, and five are foreigners. Three of the foreigners are healthcare workers, including two women, ages 26 and 58, and a 27-year-old man. It's not clear if any of the sick foreign health workers reported by the MOH are among the four acknowledged by Philippines officials.

Patients include 13 men and 7 women. All are adults, with patient ages ranging from 26 to 82 years old. All of the patients had symptoms; 15 are hospitalized in stable condition and 5 are listed as critical. As of today, 62 people are still being treated, and 8 are on home isolation.

All of the deaths occurred in previously announced case-patients. All were older adults, including four women and two men. All six had underlying medical conditions.

Since MERS-CoV was first detected in 2012 it has sickened 1,154 people in Saudi Arabia, 492 fatally, the MOH said today. So far 592 have recovered from their illnesses.

Hospital-linked illnesses at 53

The MOH said in a statement yesterday that 53 cases so far have been linked to Riyadh's National Guard hospital, King Abdulaziz Medical Center. Of the latest total, 32 patients are still hospitalized, 3 are on home isolation, 1 has been discharged, and 17 have died.

Also, the MOH spelled out steps it is taking to curb the hospital cluster and prevent hot spots in other areas. Last week an official from the WHO said that only one other hospital was affected and that five illnesses there were contained. He also said sporadic illnesses had been reported elsewhere in the city. A few weeks ago the Saudi media reported a family cluster.

The MOH said it deployed a rapid response team of infectious disease experts to the hospital to help hospital staff contain the outbreak, an epidemiology team to assist with analysis and investigation, and a public health team to help with contact tracing and testing. So far the ministry has tested more than 5,700 samples.

Infectious disease teams have been sent to all Riyadh hospitals to ensure that infection-control and prevention protocols are being followed, and medical teams from throughout Saudi Arabia's national hospital network are included in a network to monitor the outbreak and learn from it in real-time, according to the MOH.

Four Filipino nurses sickened

A Philippines government spokesman citing the country's embassy in Riyadh said today that two Filipino nurses have been infected with MERS-CoV and are hospitalized at the facility that employs them, the Manila Times reported. The women, ages 29 and 32, are receiving treatment in the ICU.

Two other Filipino health workers have been infected in the hospital outbreak as well, a 50-year-old woman and a 55-year-old man, the Times reported, adding that one is in isolation and the other is under observation with minimal symptoms. Of the four new Filipino case-patients, two had been working in the emergency department and two in the ICU.

So far 10 Filipino health workers have died from MERS-CoV while working in the Middle East, 8 while working in Saudi Arabia and 2 while in the United Arab Emirates (UAE).

WHO shares case details

The WHO on Aug 21 fleshed out clinical information on 19 MERS-CoV cases on the basis of reports it received from Saudi Arabia between Aug 13 and Aug 17. All but one of the patients is from Riyadh. The only patient without a link to the city is a 64-year-old foreign health worker from Najran who got sick on Aug 9 and was admitted to the hospital where he had been working and is listed in stable condition. An investigation into the source of his illness is still under way.

One other healthcare worker is included in the WHO's update, a 39-year-old man from Riyadh who was working at a hospital experiencing an outbreak. He is hospitalized in critical condition, and an investigation into how he was exposed is ongoing.

Fifteen of the patients were admitted to a hospital that has been experiencing a MERS-CoV outbreak, and five of them got sick while being treated for an unrelated medical condition. Six had visited the hospital's emergency department within 2 weeks of becoming sick with MERS-CoV symptoms. Last week the hospital said at least 31 illnesses since June had been linked to emergency-department exposure, with indications of many more.

Investigators are still trying to determine how 16 of the patients were exposed, while 3 are known to be contacts of earlier reported cases.

Twelve of the patients are male and seven are female. All but one are adults, with an age-range of 28 to 98 years. The child is a 2-year-old boy who is a contact of an earlier lab-confirmed case; MERS-CoV illnesses are relatively rare in children. Illness onsets range from Jul 30 to Aug 13.

The WHO also said it has been notified of four more MERS-CoV deaths in patients it reported earlier.

The latest reports from Saudi Arabia lift the global total from the disease to 1,432 cases, with at least 507 deaths. The majority of cases have been reported from Saudi Arabia.

See also:

Aug 21 WHO update

Aug 22 Saudi MOH update

Aug 23 Saudi MOH update

Aug 24 Saudi MOH update

Aug 23 Saudi MOH statement

Aug 24 Manila Times story

Aug 18 CIDRAP News story "Hospital emerges as epicenter of Riyadh MERS outbreak"

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