Saudi Arabia detects 7 more MERS cases; Jordan reports death

Saudi Arabia's health ministry today reported seven more MERS-CoV (Middle East respiratory syndrome coronavirus) cases in its latest hot spots, while Jordan reported a death from the disease.

Also, an expert on the disease who just spent a week in Saudi Arabia said testing practices in the country may explain some of the recent gush of cases, and a global animal health group commented on the latest research findings in camels, saying the studies have provided significant breakthroughs in understanding but that more work is needed to definitively say they are the primary source of the virus in humans.

Meanwhile, officials at the Indiana hospital that's caring for the first MERS case-patient in the United States said today that he is continuing to recover and that they are working on discharge plans for him.

Saudi count grows by 7

The Saudi cases were reported in Riyadh, Jeddah, and Medina. The patients are adults aged 26 to 68 years, according to a statement today from the country's health ministry. Five are women, and two are men.

Two patients are asymptomatic, two are listed in stable condition, and two are hospitalized in intensive care units (ICUs). Hospitalization dates range from Mar 28 through Apr 10. Three of the patients have underlying medical conditions such as diabetes and hypertension.

Three of the patients had been in contact with confirmed cases, but the health ministry didn't specify if any of them were healthcare workers. No exposure to camels or animal environments was listed for any of the patients.

Today's new cases—part of a dramatic spike that began in March—lift Saudi Arabia's MERS total to 421, while the number of deaths remains at 115.

Jordan reports fourth death

Meanwhile, Jordan announced a MERS death; it's not clear if the case relates to one of two recent illnesses reported by the country. A news report about the death, citing Jordan's health ministry, appeared in a Jordanian News Agency (PETRA) story in Arabic that was translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

The report said the patient was a 56-year-old who had chronic health conditions and had been on a ventilator in a hospital since May 3. It said the death is Jordan's fourth from MERS among the eight cases reported there so far.

Uncertainties about the details of some MERS cases and deaths, along with apparent delays in countries reporting the details to the World Health Organization (WHO), have made it difficult to pinpoint the global total. The European Centre for Disease Prevention and Control (ECDC), in an epidemiologic update today, put the total at 495 cases, including 141 deaths. However, its total doesn't include cases reported by Saudi Arabia yesterday and today or the most recent Jordanian cases and the new death, which would put the unofficial overall totals at 507 cases and 142 deaths.

Virologist's impressions from Saudi Arabia

In other developments, German virologist Christian Drosten, MD, today shared new information on how Saudi Arabia health officials are testing cases and contacts in an interview posted on ScienceInsider.

Global health groups have said the reasons for Saudi Arabia's rapid rise in MERS cases are unknown, but possible scenarios might include more sensitive case detection, increased zoonotic transmission, a breakdown in infection control, a change in the virus, or false-positive lab results. However, Drosten, based at the University of Bonn, said earlier in a ProMED-mail post that a genetic analysis of recent isolates showed no changes that would make the virus more infectious and transmissible in humans.

However, in the ScienceInsider interview, Drosten said case detection practices may be playing a role, but he added that his recent first-hand look at lab testing shows that methods are solid and results are reliable. He said Saudi Arabia is now doing polymerase chain reaction (PCR) tests not only on patients with pneumonia who are in ICUs but also on contacts of patients. Illustrating the increase in testing, he said 459 PCR tests were done in all of Saudi Arabia last year but that in March, 4,629 were done in the city of Jeddah alone.

Drosten told ScienceInsider that the test results on asymptomatic healthcare workers often yield weak signals."These people probably just have a very low concentration of virus in the throat. It's hard to interpret. It's possible that these are infections that are quickly controlled by the immune system."

He also aired concerns about Saudi Arabia's apparent sidelining of the expertise of Western-trained epidemiologist Ziad Memish, MD, the country's deputy health minister. Memish's role appears to have been diminished, especially in light of the appointment of a new health minister, he said. He told ScienceInsider that Memish has built up an impressive network that is no longer being used now that the health minister has formed a new advisory committee that's heavy on clinicians and clinical microbiologists.

FAO: Studies on camel-human link needed

Meanwhile, the United Nations Food and Agriculture Organization (FAO) today weighed in on the surge in human cases and recent research developments in dromedary camels, suspected as the primary source of infection for humans. It said the studies provide a better understanding of the disease and show evidence of infection in camels, including a study from Saudi Arabia showing that MERS-CoV samples matched those from humans and that the isolates could be grown in the lab and have the potential to infect humans.

The FAO said the recent results suggest camels may act as an intermediate host of the virus, but that more studies are needed to verify the role of camels and to sort out how the virus passes to humans. The agency said the strength of the link between humans and camels needs to be assessed to determine whether people in contact with camels are more likely to be infected than those with no contact.

"This information is crucial in order to devise a strategy aimed at halting the source of infection and protecting humans," the FAO said, adding that it and its partners are working with national officials to support animal MERS studies. It announced a consultation meeting on MERS, which will be held in Muscat, Oman, on May 20 and 21.

The agency urged nations to commit to targeted investigations and information sharing, to coordinate investigations with public health officials, and to establish a systematic search for the source of infection in animals and the environment.

US patient improving

Also today, the first US MERS-CoV patient, in isolation at Community Hospital in Munster, Ind., continues to improve and is in good condition, hospital officials said in an e-mailed statement today.

"The hospital has begun working on discharge plans for the patient, who is expected to be released to home isolation in the coming days," the statement said. "He will remain in home isolation until he is cleared by the Indiana State Department of Health (ISDH) and Centers for Disease Control and Prevention (CDC) as no longer an infectious risk to the public."

The patient is a man in his 60s who is a US citizen but lives in Riyadh, Saudi Arabia, and works in healthcare there. He flew to the United States on Apr 24 to visit relatives, and was admitted to the Munster hospital on Apr 28. His case was announced on May 2.

See also:

May 6 Saudi MOH statement on 7 cases

Saudi MOH MERS page with case count

May 6 AFD post

May 6 ECDC MERS epidemiological update

May 6 ScienceInsider report

May 6 FAO statement

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