Italy resident has MERS after trip to Jordan

May 31, 2013 (CIDRAP News) – Italy announced its first Middle East respiratory syndrome coronavirus (MERS-CoV) case today, in a man who recently spent time in Jordan, site of the first known MERS illnesses, according to media reports.

Also today, the World Health Organization (WHO) confirmed earlier reports of another apparent hospital cluster of MERS-CoV cases in Saudi Arabia, involving five patients whose cases were reported 3 days ago.

In Italy, the health ministry said MERS was diagnosed in a 45-year-old man who is a foreigner living in Italy, according to a Reuters report today. He recently spent 40 days in Jordan, where one of his sons was suffering from "an unspecified flu," the story said.

The man was hospitalized in Tuscany with a high fever, a cough, and difficult breathing, but he is now in good condition and being monitored in isolation, Reuters reported.

Unofficially, the new case raises the global MERS-CoV count to 51 cases with 30 deaths. The WHO, which has not yet noted the Italian case, listed its count today at 50 cases, including 30 deaths.

Italy now joins a short list of countries outside the Middle East that have had MERS-CoV cases, all of them tied directly or indirectly to Middle Eastern countries. France, Germany, Tunisia, and the United Kingdom have all had cases. Most were in patients who became ill after traveling in the Middle East, but a few apparently caught the virus from returned travelers, and a few others lived in the Middle East and were transferred to European hospitals for treatment after they got sick.

Jordan had the first cases of MERS-CoV when a cluster of illnesses occurred in hospital workers in April 2012. The virus was unknown at the time, but it was identified in stored samples from two of the patients in November.

Saudi hospital cluster
The WHO, in a new "MERS-CoV summary and literature update" today, said the five cases announced by Saudi Arabia on May 28 involved patients who were all in the same hospital. The agency said they were not from the Al-Ahsa region, where a hospital-centered cluster that began in April involved 22 cases and 10 deaths.

"An official from the Ministry of Health has been quoted as saying that all were patients in the same hospital and that two had shared a hospital room," the WHO said. "None of the patients have family contacts in Al-Ahsa. The Ministry of Health is continuing investigations to determine source of transmission in this cluster."

The cluster was mentioned earlier this week in a Canadian Press report that quoted a Saudi health official.

As noted in a WHO report on May 29, three of the five patients died. They ranged in age from 56 to 85 years, three were male, and all had multiple co-morbid conditions. They were admitted to the hospital between May 12 and 24 with pneumonia or respiratory symptoms, according to today's report.

The WHO summary also offered some additional information on the three Tunisian cases of MERS-CoV that were first reported on May 20. It said the index case-patient traveled to Qatar in late March, returned to Tunisia briefly, and then went back to Qatar for 3 weeks before falling ill 5 days after returning home.

He tested negative for the virus, but "the quality of the specimen may have been poor," the agency said. Two of his children had mild illnesses and tested positive for the virus.

In a separate MERS-CoV update today, the WHO noted the death of a 61-year-old Saudi Arabian man from Al-Ahsa, apparently the patient whose case was announced by the Saudi Ministry of Health 2 days ago. The WHO said he had underlying medical conditions and fell ill on May 20.

See also:

May 31 Reuters story on case Italy

May 31 WHO summary of MERS situation

May 31 WHO update on cases

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