Health officials in the Philippines today announced the country's second imported MERS-CoV case this year, in a traveler from the Middle East, as the total in South Korea's hospital outbreak—also triggered by a traveler—grew to 186 cases.
Elsewhere, Saudi Arabia over the past 4 days reported one more MERS-CoV (Middle East respiratory syndrome coronavirus) case, as the World Health Organization (WHO) fleshed out more information on other recent cases, including some linked to a hospital outbreak in Hofuf.
Philippines case has Mideast ties
The Philippines Department of Health (DOH) today said a 36-year-old man from an unnamed Middle East country tested positive for MERS-CoV on Jul 4 and has been admitted to the country's Research Institute for Tropical Medicine for observation, CNN Philippines reported. Quoting a DOH spokesperson, it said the man has a low viral load and was on the 14th day of incubation when he was tested.
The infection is the second imported MERS case detected in the Philippines. The first involved a female nurse whose infection was detected in February after she started having symptoms upon her return from Saudi Arabia. In the spring of 2014 the Philippines reported an asymptomatic infection in a nurse who had recently returned from the United Arab Emirates.
Media reports and a notice posted on the DOH Web site didn't say where the man was from, but some reports said the man arrived in Manila from Dubai on Jun 19. A report from the BBC said the man had a stopover in Saudi Arabia on his way to Manila. It said he had his first symptoms on Jul 2, which is well after he arrived in the Philippines.
A DOH statement translated and posted by FluTrackers, an infectious disease news message board, said the patient is in stable condition and, due to his low viral load, is possibly already recovering. It noted that the government has activated its MERS task force and is tracing people who may have had contact with the man.
South Korea cases reach 186
Meanwhile, South Korea reported three additional MERS-CoV cases over the past 4 days, two of them in healthcare workers, lifting the overall total to 186 cases, according to Ministry of Health (MOH) daily updates. No new deaths have been reported, keeping the total at 33.
The two health workers include a nurse at Samsung Medical Center whose illness was announced on Jul 3 and a doctor from the same facility whose infection was announced on Jul 4. Samsung Medical Center, in Seoul, became the outbreak's worst affected hot spot after a patient from the index hospital unknowingly spread the virus to staff, patients, and visitors when he spent nearly 3 days in the emergency department (ED) there in late May.
The latest patient, whose MERS-CoV infection was announced yesterday, is the spouse of an earlier announced case linked to Samsung's ED.
The illness in the 50-year-old is raising more questions about the incubation period for MERS-CoV, the Korea Herald reported yesterday. It said authorities are still investigating how she was infected by the virus, and her symptoms may have started a week after 14-day incubation period. It said her symptoms began on Jul 2, about 21 days after she was isolated from her husband.
Authorities suspect that she was exposed by her husband and symptoms surfaced later, due to her compromised immune system due to cancer, according to the report. However, after her husband was hospitalized for MERS-CoV, she visited Samsung Medical Center for cancer treatment, and health officials are exploring the possibility that she was infected there.
The number of possible contacts being monitored has fallen below 1,000 in an outbreak that has slowed to a slow trickle. The ministry said as of today, 907 people are under quarantine, including 664 being monitored at home. So far 15,419 people have finished their quarantine period.
In a Jul 3 update, the WHO said so far all of South Korea's MERS-CoV cases, except for the index one, are linked to a single transmission chain associated with healthcare facilities. It said the government is still adding new contacts each day as they are identified. The WHO added that the Korean government has said it will provide advance health insurance payments to hospitals that are having financial problems because of the MERS outbreak.
Saudi Arabia reports new case
Elsewhere, Saudi Arabia reported one new patient in the past 4 days, a 35-year-old male foreigner from Turubah, in the southwestern part of the country not far from Mecca, according to a Jul 3 statement.
The man is not a healthcare worker and is in stable condition, the Saudi MOH reported. So far the investigation has found no links to suspected or confirmed MERS cases in the community or hospital. His illness raises Saudi Arabia's number of MERS-CoV infections to 1,045. No new deaths have been reported, so the fatality count remains at 460, according to the MOH.
The number of people who have recovered from their illnesses is at 578, and 7 people are still being treated.
WHO report covers hospital infections
On the same day that Saudi Arabia announced its most recent case the WHO provided more details on six cases the country reported between Jun 19 and Jun 30, including four from Hofuf, a town in the eastern part of the country that has been the setting for hospital and family MERS clusters over the past several weeks.
The patients in Hofuf include a 41-year-old man with an underlying medical condition who is related to an earlier announced patient who works at a hospital experiencing an ongoing MERS-CoV outbreak, a 60-year-old healthcare worker with an underlying medical condition who works at an outbreak hospital, a 61-year-old woman who had been admitted to an outbreak hospital, and a 52-year-old man who got sick with MERS-CoV while hospitalized for an unrelated condition.
The other two patients are both from Riyadh, which has reported several cases over the last few weeks. They include a 65-year-old woman and a 40-year-old man, and investigations into how they were exposed to the virus are still under way.
Illness onsets for the six patients range from May 30 to Jun 24. Ages range from 40 to 65 years old. Three are in critical condition, and three are listed as stable.
The WHO said Saudi Arabia also notified it of the death of a previously reported case-patient. The agency said that, since the disease emerged in September 2012, it has received reports of 1,363 lab-confirmed MERS cases, at least 487 of them fatal.
See also:
Jul 6 CNN Philippines story
Jul 6 BBC report
Jul 6 FluTrackers thread
Feb 11 CIDRAP News scan "Philippines reports imported MERS case"
Jul 3 Korean MOH press release
Jul 4 Korean MOH press release
Jul 5 Korean MOH press release
Jul 6 Korean MOH press release
Jul 6 Korea Herald story
Jul 3 WHO statement on South Korea's outbreak
Jul 3 Saudi MOH statement
Jul 3 WHO statement on MERS-CoV in Saudi Arabia
