Friday, May 31, 2013

WHO: MERS-CoV summary and literature update – as of 31 May 2013

Since April 2012, there have been 50 laboratory-confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Thirty of these cases have died. Local transmission from non-human exposures appears to have occurred in several countries in the Middle East, including Jordan, Qatar, Saudi Arabia and the United Arab Emirates (UAE). Cases have also been reported by three countries in Europe—France, Germany, and the United Kingdom (UK)—and by Tunisia, in North Africa. All the European and North African cases have had a direct or indirect connection to the Middle East. However, in France, the UK and Tunisia, there has also been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a sick traveler recently returned from the Middle East. No case has been reported in Jordan since April 2012.

The most recent cases have occurred in Saudi Arabia and Tunisia. Two laboratory-confirmed cases and one probable case of MERS-CoV have been reported by Tunisia. In this family cluster, the index case, who was not laboratory confirmed, was a male Tunisian who traveled to Qatar in late March. He then left Qatar briefly, returning a few days later. He remained in Qatar for about 3 weeks before returning home to Tunisia. He became ill 5 days later and died after a week. He tested negative for MERS-CoV, but the quality of the specimen may have been poor. Two adult children, one who traveled to Tunisia from Qatar and one who lives in Tunisia and had not traveled, also became ill, with mild symptoms, and both tested positive for MERS-CoV.
Five new cases of MERS-CoV infection were reported by the Saudi Arabian Ministry of Health on 28 May 2013. The cases occurred in the eastern province of Saudi Arabia, but are not from the Al-Ahsa area. They range in age from 56 to 85 years, three were male, and three of these five patients have died. All were reported to have multiple co-morbid conditions and were admitted to hospital between 12-24 May, with pneumonia or respiratory symptoms. 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. 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. An additional case, a 61-year-old man with chronic renal failure and other chronic diseases, was reported from Al-Ahsa on 29 May.

Thus far, all clusters of cases have occurred in a health care setting or among close family contacts. Human-to-human transmission has been documented on several occasions in which secondary cases had not traveled to affected areas and is strongly suspected in others. Transmission does not appear to have extended beyond these clusters into the larger community in any of the events. The mode of transmission has not been defined in any of the clusters. 

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