A second MERS-CoV (Middle East respiratory syndrome coronavirus) case was reported in the Netherlands today, while Saudi Arabia cited three new cases. In addition, scientists said serologic testing has retrospectively confirmed seven more cases in the first known MERS-CoV outbreak, which occurred in Jordan in April 2012.
Also today, the World Health Organization (WHO) released an update that confirmed and added information on 18 recent cases, including 14 in the United Arab Emirates (UAE) and single cases in the Netherlands, the United States, Jordan, and Lebanon.
Second Dutch case linked to first
The new case in the Netherlands involves a female relative of the country's first case-patient, a man who fell ill after a recent trip to Saudi Arabia, according to the National Institute for Public Health and the Environment. A computer translation of the statement was posted on Avian Flu Diary, an infectious disease blog.
The agency said the woman, like the man, became infected in Saudi Arabia, and she is now in "strict isolation" and stable condition. She and the man shared a hotel room for 2 weeks, and both have underlying conditions, the statement said.
Today's WHO statement said the first Dutch patient is a 70-year-old Dutch citizen who traveled to Saudi Arabia between Apr 26 and May 10. He first felt ill while in Medina on May 1, and on May 6 he was examined in Mecca.
He had no respiratory symptoms until his return home on May 10, and he was hospitalized the same day, the WHO said. He is now in stable condition in an intensive care unit (ICU).
Three more cases in Riyadh
The three new cases reported in Saudi Arabia today include one death. All three are in Riyadh, which is a hotbed of recent MERS activity, ranking second behind Jeddah in the number of cases.
The fatal case involved a 54-year-old woman who had chronic conditions and was hospitalized May 3 with an arteriovenous fistula, the Saudi Ministry of Health (MOH) said in its update. She experienced respiratory symptoms on May 5 and was subsequently moved to an ICU; she died on May 13.
A second case-patient is a 70-year-old woman who has chronic conditions but has no symptoms and is in home isolation, the MOH said. The other patient is a 39-year-old woman who has diabetes and was hospitalized with respiratory symptoms on Apr 24. After twice testing negative for MERS-CoV, she tested positive on May 13, and she is in stable condition.
The MOH didn't give any information about how the three women were exposed to the virus, nor did it say whether any of them are healthcare workers (HCWs).
The new cases raise Saudi Arabia's MERS tally to 514 cases with 160 deaths.
The ministry also reported two deaths in previously reported cases, involving a 72-year-old woman and a 63-year-old man, both in Jeddah.
Jordan cases retrospectively confirmed
The earliest known MERS-CoV outbreak occurred in a Zarqa, Jordan, hospital in April 2012, but it was not recognized as such until November 2012, after the virus had been identified and described as a result of cases in Saudi Arabia.
The outbreak involved 13 pneumonia cases, including 2 deaths. Investigators previously confirmed MERS-CoV in the two fatal cases by testing stored specimens, leaving the other 11 cases in the suspected category. Now Jordanian and US investigators have confirmed seven more cases through serologic (antibody) tests, according to their report published yesterday in Clinical Infectious Diseases.
The authors interviewed and collected serum samples from 124 people, including the outbreak patients, their household contacts, HCWs, and field investigators from the Jordanian health ministry. Among those tested were 9 of the 11 surviving outbreak patients.
Seven people tested positive for MERS-CoV antibodies on at least two of three serologic tests, increasing the outbreak count to nine. Of the 7 newly confirmed cases, 6 were surviving outbreak patients, and 5 were HCWs, according to the report.
With 6 HCWs among the 9 cases in the outbreak, the attack rate among potentially exposed HCWs was 10%, the authors found. There was no evidence of MERS CoV transmission at two hospitals to which outbreak patents were transferred and which, the authors said, had better infection control practices than the outbreak facility.
Of the 9 cases in the outbreak, 6 people were male, and the median age was 40 years. Most of the patients had no major preexisting conditions, although two had hypertension. Their relative youthfulness and their generally good underlying health probably explains why the outbreak case-fatality rate of 22% was lower than has been observed in MERS cases generally, the authors say.
The authors determined that each of the serologically confirmed case-patients had been exposed to at least one patient whose infection was confirmed by polymerase chain reaction.
The study shed no light on the source of the virus: The authors found no evidence that any patients had contact with camels, and none of them had traveled to or received visitors from the Arabian Peninsula before they got sick.
WHO update
Most of today's WHO update deals with 14 MERS cases reported by the UAE, but it also reviews recent US, Dutch, Lebanese, and Jordanian cases.
The UAE cases were reported to the WHO on Apr 8, May 8, and May 11. Seven of the 14 patients are described as HCWs and several of them as expatriates. The age range is from 30 to 68 years. Three patients were listed as asymptomatic.
Most of them had no contact with other confirmed cases, and none reported contact with animals, according to the statement. Several of the cases were identified as a result of general screening at their workplaces.
The WHO provided some new details on Lebanon's first MERS case, which was reported a week ago in media reports that contained very little information. The WHO said the patient is a 60-year-old male HCW and Lebanese national who got sick on Apr 22.
He was hospitalized on Apr 30 and tested positive for MERS-CoV 2 days later, the agency said. On May 7 was he was released from the hospital.
Eight weeks before his illness, the man had traveled to Jeddah, where he visited one of the hospitals that recently has had a surge of MERS cases, the WHO said. In addition, he visited the UAE 5 weeks before his illness, but he did not travel in the 2 weeks before he got sick.
The WHO increased its global MERS count to 572 cases, including 173 deaths. The number includes 58 cases that Saudi Arabia reported to the agency from May 5 to 9. The WHO said it is gathering more information about those cases in preparation for providing further updates.
Florida HCWs test negative
In developments related to the second imported US MERS case, the Florida Department of Health (FDH) in Orange County said today that the patient, hospitalized in Orlando, continues to improve and that tests are negative for all HCWs who had contact with him.
Yesterday health officials announced that tests cleared two health workers who had flu-like symptoms after unprotected contact with the patient, a HCW who lives and works in Jeddah, Saudi Arabia, and started feeling ill on a flight to visit the United States. The 44-year-old man sought care on May 8 at a Florida hospital, and tests on May 11 revealed that he was infected with MERS-CoV.
Staff writer Lisa Schnirring contributed to this story.
See also:
May 15 Avian Flu Diary post with Dutch statement on second case
May 15 Saudi MOH report on three new cases
May 14 Clin Infect Dis abstract on Jordanian outbreak
Jun 19, 2013, CIDRAP News story on Jordan outbreak
May 15 WHO statement
May 15 FDH statement
