A ProMED-mail post
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International Society for Infectious Diseases
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In this report:
[1] Saudi Arabia - MOH report, 3 new cases, details
[2] Saudi Arabia - details on 7 cases reported 2 May 2013
[3] WHO update 2 May 2013
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[1] Saudi Arabia - MOH report, 3 new cases, details
Date: May 3, 2013, 7:16:49 AM EDT
From: Ziad Memish <zmemish@yahoo.com>
Subject: Urgent update nCOV cluster KSA
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This is a preliminary update on the status as of a few minutes ago. Three further cases have been discovered from the investigation which is still ongoing:
Case 8: 53 y.o. female with comorbidities. Date of symptoms [27 Apr 2013] she is in stable but critical condition
Case 9: 50 y.o. male with comorbidity. Date of symptoms [30 Apr 2013] with pneumonia and he is well on the inpatient ward.
Case 10: 33 y.o. male with comorbidity. Family contact of a deceased patient. Date of symptoms [28 Apr 2013]. Inpatient in the medical ward and doing well.
As stated earlier our investigation of contacts and active screening of inpatients who fit case definition is ongoing.
--
Ziad A Memish,MD,FRCP(Can),FRCP(Edin),FRCP(Lond),FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia
<zmemish@yahoo.com>
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[2] Saudi Arabia - details on 7 cases reported 2 May 2013
Date: May 3, 2013, 5:15:28 AM EDT
From: Ziad Memish <zmemish@yahoo.com>
Subject: Urgent update on nCOV from KSA
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The following is the summary of the 7 reported cases confirmed microbiologically as of yesterday [2 May 2013]. Prior information was based on preliminary testing both to WHO and the press; we now confirm the following results.
Case 1: 59 y.o. male with multiple comorbidities. Date of onset of symptoms [14 Apr 2013] and passed away [19 Apr 2013].
Case2: 24 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and still in ICU in critical but stable condition.
Case 3: 87 y.o. male with multiple comorbidities. Date of symptoms [17 Apr 2013] and passed away [28 Apr 2013].
Case 4: 58 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] still in ICU in stable but critical condition.
Case 5: 94 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [26 Apr 2013].
Case 6: 56 y.o. male with multiple comorbidities. Date of Symptoms [22 Apr 2013] and passed away [30 Apr 2013].
Case 7: 56 y.o. male with multiple comorbidities. Date of symptoms [22 Apr 2013] and passed away [29 Apr 2013].
As the NFP for KSA you should know that the investigations are ongoing and include both testing and epidemiology investigations of family members and healthcare workers. So far we have not found symptomatic infection in any healthcare workers linked to these cases. Family investigations for 3 families are to be completed tomorrow [4 May 2013]; the others will be done as we gain access. Sensitivities around grieving are of course an issue.
--
Ziad A Memish,MD,FRCP(Can),FRCP(Edin),FRCP(Lond),FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia
<zmemish@yahoo.com>
******
[3] WHO update 2 May 2013
Date: 2 May 2013
Source: WHO Global Alert and Response
http://www.who.int/csr/don/2013_05_02_ncov/en/index.html
Novel coronavirus infection - update, 2 May 2013
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The Ministry of Health in Saudi Arabia has informed WHO of 7 new laboratory confirmed cases of infection with the novel coronavirus (nCoV), including 5 deaths.
Two patients are currently in critical condition.
The government is conducting ongoing investigation into this outbreak.
Preliminary investigation show no indication of recent travel or animal contact of any of the confirmed cases. The confirmed cases are not from the same family.
From September 2012 to date, WHO has been informed of a global total of 24 laboratory confirmed cases of human infection with nCoV, including 16 deaths.
Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.
All MS are reminded to promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course.
WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.
WHO continues to closely monitor the situation.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[ProMED-mail would like to thank Dr. Memish for sharing details of the recent cluster of severe illnesses associated with infection with the novel coronavirus (nCoV) in Saudi Arabia. From the dates of onset of some of the earlier cases, it seems to suggest there may have been a common exposure(s) and possibly followed by some person-to-person spread -- the 1st case had onset on 14 Apr 2017; the next 2 additional cases had onset 3 days later on 17 Apr 2013, followed by 4 additional cases with date of onset 5 days later on 22 Apr. The 3 newer cases (1st reported today 3 May 2013) had dates of onset 27 Apr 2013, 30 Apr 2013 and 28 Apr 2013, only this latter case (with date of onset 28 Apr 2013) is identified as a definite family contact of an earlier onset deceased patient.
Of these 10 newly reported cases, all 10 (100 percent) have a history of one or more comorbidities, suggesting a predisposition to more severe illness when confronted with a serious infection. The ages range from 24 years of age to 94 years of age, with the mean age of 57 years (by 10 year age cohorts: 20-29 years old - 1 case; 30-39 years old - 1 case; 40-49 years old - 0 cases; 50-59 years old - 6 cases, 60-69 years old - 0 cases; 70-79 years old - 0 cases; 80-89 years old - 1 case; 90-99 years old - 1 case).
According to information in yesterday's (2 May 2013) report (see Novel coronavirus - Eastern Mediterranean (16): Saudi Arabia, RFI 20130502.1686948), this cluster of cases are all from Ahsaa province. According to Wikipedia, "Al-Ahsa, sometimes Al-Hasa, El Hasa, or Hadjar is a traditional oasis region in eastern Saudi Arabia whose name is used by the Al-Ahsa Governorate, which makes up much of that country's Eastern Province. The oasis is located about 60 km inland from the Persian Gulf. Al-Ahsa is part of the region known historically as Al-Bahrayn, which includes the eastern coast of the Arabian Peninsula down to the borders of Oman, and also includes the island of Awal (modern-day Bahrain)." While Al-Ahsa is part of the Eastern Province, it is the largest area within the province and is often locally considered a province on its own. It is the major date producing region, with 10 000 hectares of agricultural lands, it produces approximately 21 000 tons of dates annually, has more than 30 000 farms producing fruits and vegetables and has more than 2 million palm trees. (seehttp://en.wikipedia.org/wiki/Al-Hasa for more details on the history of this region).
Of note, very early on in our reports on this nCoV, subscriber Merritt Clifton
Editor of Animal People, suggested that as a major date producing region of the world, it was possible that nCoV infected bats might be feeding on the dates as a possible link for the species jump of a bat CoV to either intermediate animal hosts or directly to humans, as seen with the Nipahvirus outbreaks in Bangladesh. The occurrence of a large cluster (10 cases with dates of onset in a 16 day period) occurring in the date producing region where presumably there is a high concentration of bats, is interesting and very suggestive.
We await further information on results of epidemiologic investigations on the cases in this cluster.
For the HealthMap/ProMED map of Saudi Arabia and the surrounding countries, see http://healthmap.org/r/1HAJ. For a map showing the location of Al-Ahsa, see http://en.wikipedia.org/wiki/Al-Hasa, and for maps of Saudi Arabia showing provinces, seehttp://mapsof.net/map/saudi-arabia-regions-map#.UYPOLkqxnts and http://mapsof.net/map/saudi-arabia-2003-cia-map#.UYPOpUqxnts. Note that Riyahd (where earlier cases were reported) - is not far from the location of Al-Ahsa. - Mod.MPP]
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