MERS Outbreak Centered In Riyadh KSA

niman · August 19, 2015

WHO and media reports describe growing outbreak in Riyadh.

niman · August 19, 2015

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
18 August 2015

Between 10 and 12 August 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

A 57-year-old male from Riyadh city developed symptoms on 8 August while admitted to hospital for an unrelated medical condition since 2010. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 11 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 56-year-old female from Riyadh city developed symptoms on 7 August while admitted to hospital for an unrelated medical condition since 29 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 9 August. Currently, she is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.
A 78-year-old female from Riyadh city developed symptoms on 7 August while admitted to hospital for an unrelated medical condition since 26 July. The patient, who has comorbidities, tested positive for MERS-CoV on 8 August. Currently, she is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.
A 58-year-old male from Abha city developed symptoms on 6 August and was admitted to hospital on 10 August. The patient, who has comorbidities, tested positive for MERS-CoV on 12 August. He has a history of contact with camels and consumption of their raw milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
A 63-year-old male from Riyadh city developed symptoms on 29 July and, on 3 August, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 5 August. He visited the emergency room of the same hospital due to his chronic conditions in the 14 days prior to the onset of symptoms. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing. Currently, the patient is in critical condition in ICU.
A 45-year-old male from Riyadh city developed symptoms on 4 August while admitted to hospital for an unrelated medical condition since 30 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 6 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 56-year-old male national from Riyadh city developed symptoms on 4 August while admitted to hospital for an unrelated medical condition since 23 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 5 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 99-year-old male from Riyadh city developed symptoms on 6 August while admitted to hospital for an unrelated medical condition since 23 May. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 8 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 65-year-old male from Riyadh city developed symptoms on 8 August and, on the same day, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 9 August. He is a contact of a laboratory-confirmed MERS-CoV case (see DON published on 12 August – case n. 3). Investigation of history of exposure to other known risk factors is ongoing. Currently, the patient is in stable condition admitted to a negative pressure isolation room on a ward.
A 57-year-old male from Riyadh city developed symptoms on 1 August and, on 4 August, was admitted to hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who has comorbidities, tested positive for MERS-CoV on 6 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 57-year-old male from Riyadh city developed symptoms on 29 July and, on 30 July, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who has comorbidities, tested positive for MERS-CoV on 2 August. Currently, he is in stable condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
A 73-year-old female from Riyadh city developed symptoms on 31 July and, on 2 August, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. She had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who had comorbidities, tested positive for MERS-CoV on 4 August and passed away on 11 August. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 1 MERS-CoV case that was reported in a previous DON on 12 August (case n. 14).

Globally, since September 2012, WHO has been notified of 1,413 laboratory-confirmed cases of infection with MERS-CoV, including at least 502 related deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

Public health authorities in host countries preparing for mass gatherings should ensure that all recommendations and guidance issued by WHO with respect to MERS-CoV have been appropriately taken into consideration and made accessible to all concerned officials. Public health authorities should plan for surge capacity to ensure that visitors during the mass gathering can be accommodated by health systems.

http://www.who.int/csr/don/18-august-2015-mers-saudi-arabia/en/

niman · August 19, 2015

Hospital emerges as epicenter of Riyadh MERS outbreak

Lisa Schnirring | Staff Writer | CIDRAP News

|

Aug 18, 2015

A quickly growing MERS-CoV outbreak in Riyadh, Saudi Arabia, involves one main hospital, King Abdulaziz Medical City, with at least 31 illnesses since June linked to emergency department (ED) exposure, officials say, and indications of many more to come.

Also, the country announced 10 new MERS-CoV (Middle East respiratory syndrome coronavirus) cases today, 9 in Riyadh likely linked to the hospital.

Saudi Arabia's Ministry of Health (MOH) started announcing a steady stream of MERS cases at the end of July that has accelerated in recent days, with hints over the past several weeks that healthcare and family clusters are involved.

Updates from the World Health Organization (WHO) over the past few weeks have fleshed out some of the hospital exposures, and an update today on 12 Saudi patients revealed that 4 got sick after visiting the ED and 9 acquired MERS-CoV during hospitalization for unrelated conditions at a facility undergoing an outbreak.

Main hospital revealed

Peter Ben Embarek, PhD, who leads the WHO's MERS response, told CIDRAP News that the vast majority of recent and current cases are related to one hospital, a national guard hospital in Riyadh. He added that there is a small outbreak at another hospital involving five cases, as well as sporadic cases not linked to the main hospital.

Ben Embarek said the smaller hospital outbreak is under control.

King Abdulaziz Medical City has about 690 beds and was established in 1983 to care for National Guard soldiers and their families. The government-funded hospital was combined with many other medical centers and inaugurated as a "medical city" in 2001.

King Abdulaziz Medical City said in an Aug 15 press statement that 31 MERS-CoV infections have been reported in people who visited the facility's ED between June and Aug 14. Dr Hanan Balkhi, the hospital's director of infection prevention and control, said in the statement that, in addition, 4 healthcare workers have tested positive and are in home isolation.

The hospital said a number of suspected MERS cases have also been reported and are under investigation. So far 12 deaths have been reported in connection to the outbreak, the hospital said.

In announcing steps to curb the spread of the outbreak, the hospital hinted that overcrowding in the ED may be a contributing factor, a pattern that also helped fuel the large hospital-linked outbreak in South Korea this spring and summer.

Balkhi said because of the rising number of MERS cases, along with around-the-clock large numbers of patients in the hospital's ED and difficulty applying quarantine measures, the facility will limit the number of patients in the ED and outpatient clinics. It will also suspend all surgeries that aren't urgent, suspend all same-day and short-day surgeries, and set aside special areas to quarantine suspected and isolate confirmed patients, including in the intensive care unit.

The hospital has limited visiting hours and has restricted the number of visitors and said it will reassess its control steps as needed. It said it is collaborating with the MOH on handling the outbreak.

Experts critique control measures

Ben Embarek said the WHO is in regular contact with the hospital and that different ways of supporting the country are being discussed, including a possible joint mission.

In February, a team of international health officials visited Saudi Arabia in response to a surge of infections in the country. They found critical data gaps on how and why MERS-CoV illnesses keep occurring in the community and how to improve prevention in hospitals and clinics.

One of the conclusions was that infections were still occurring in some healthcare facilities, but not others, a sign that infection control measures were effective, but not broadly implemented.

A similar joint mission to South Korea in June in the wake of its hospital-linked outbreak identified infection control lapses and complex dynamics, including ED crowding that was amplified by sick patients moving between hospitals. The team concluded, however, that overall the pattern resembled similar hospital-linked outbreaks in the Middle East.

Latest 10 cases

In other developments, Saudi Arabia's MOH today reported 10 new lab-confirmed MERS-CoV cases, one of them fatal, all in Riyadh. Investigations found that all but one had contact with a suspected or confirmed MERS case.

Two of the patients are foreign nationals, one of them a 35-year-old woman who is listed as a healthcare worker. The other is 71-year-old man who died from his infection.

Overall, patient ages range from 28 to 86. Five are hospitalized in stable condition, and four are listed in critical condition.

Also, the MOH said that an earlier announced patient died from his infection, a 71-year-old foreigner who had an underlying medical condition.

The latest cases boost Saudi Arabia's MERS total to 1,115 cases, 480 of them fatal. Currently, 42 people are still being treated for their infections, and 590 have recovered.

WHO on 12 recent cases

Meanwhile, the WHO today filled in more details about 12 cases reported by Saudi Arabia from Aug 10 to Aug 12. One of the infections was fatal, involving a 73-year-old woman who got sick after visiting an ED for an unrelated medical condition.

All but one of the cases is from Riyadh. The other case was reported in Abha in a 58-year-old man who has a history of contact with camels and consuming their raw milk.

Of the Riyadh patients, four got sick after visiting the ED and nine contracted MERS-CoV while they were being treated for other conditions in a hospital that has been experiencing a MERS-CoV outbreak. One of them, a 65-year-old man, was a contact of an earlier reported case.

Illness onsets for the 12 cases range from Jul 29 through Aug 8. Patient ages range from 45 to 99. Nine are men, and three are woman. Nine of them are hospitalized in critical condition, and two are listed as stable.

The WHO also said that Saudi officials reported an additional death in an earlier reported case. Globally since September 2012 the WHO has received reports of 1,413 lab-confirmed MERS-CoV cases, with at least 502 deaths.

See also:

Aug 15 King Abdulaziz Medical City press release

Aug 18 Saudi MOH statement

Aug 18 WHO statement

Feb 23 CIDRAP News story "WHO notes stubborn MERS puzzles as Saudi cases climb"

http://www.cidrap.umn.edu/news-perspective/2015/08/hospital-emerges-epicenter-riyadh-mers-outbreak

niman · August 19, 2015

Preventive Measures Upgrade to Address Coronavirus in KAMC-R

In regards to the cases of MERS-Coronavirus at King Abdulaziz Medical City –Riyadh, the Executive Director of Infection Prevention and Control Department at MNG-HA, a member of the National Scientific Committee of Infectious Diseases at the Ministry of Health Dr. Hanan Balkhi, stated that since June 2015 to August 14th, 2015, 31 positive cases have been reported of patients who visited the ER in addition to 4 positive cases of health practitioners. A number of suspected cases have been reported in the last 24 hours as well, which are now subject to extensive clinical and laboratory tests.

In addition, the number of confirmed MERS-Coronavirus deaths are 12 cases by the latest statistics, given that this type of respiratory virus is most deadly to those who suffer from chronic diseases such as diabetes, blood pressure and kidney failure.

Dr. Hanan Balkhi also pointed out that the confirmed cases amongst health workers were discovered through the conducting an epidemiological investigation, who are now subject to Home Care Quarantine, and no record of death cases have been reported.

Furthermore, Dr. Hanan explained that in view of the latest developments about the increasing number of cases of MERS-Coronavirus, and due to the around the clock large numbers of patients in the ER at KAMC-R and the difficulty of applying quarantine measures, preventive measures plans have been upgraded in order to deal with the epidemiology and to control the infection by taking the following measures:

Reduce the numbers of patients / return patients in the ER.
Reduce the numbers of patients / return patients in the outpatient clinics.
Suspend all non-emergency and non-urgent operations and surgeries.
Suspend all day case and short stay surgeries.
Allocate three wings to accommodate the quarantine of suspected / confirmed cases.
Allocate a quarantined Intensive Care Unit to accommodate critical cases.
Reduce Visitation Hours and the number of visitors.

In addition to the emphasis on health practitioners to comply with all the infection control procedures and standards, since they are the most vulnerable to be infected due to direct contact with infected patients.

Note that this epidemiology plan will be evaluated on a daily basis and will be adjusted as required.

Dr. Hanan, as a member of the National Scientific Committee of Infectious Diseases at the Ministry of Health pointed out that confirmed cases of MERS-Coronavirus will be recorded from various health sectors on a daily basis on to the Health Electronic Surveillances Network (HESN) at the Ministry of Health, and communication with the Command and Control Center at the Ministry of Health is continuous in order to activate the procedures to be followed at a national level to control infection and reduce the spread of infectious diseases. While confirming that the Ministry of National Guard - Health Affairs is deals with the current situation with complete transparency and high professionalism in collaboration with the Ministry of Health and the concerned authorities.

Last but not least, Dr. Hanan highlighted the importance of active cooperation of the patients and visitors to King Abdulaziz Medical City - Riyadh by following the awareness tips that are distributed and presented across through visual aids and social media networks to avoid going to emergency departments, except in critical situations or injuries that require undergoing ambulatory procedures, and to reduce your visits to inpatients as much as possible, and to commit to applying the correct ways to stop the spread of the germs expelled from the mouth and nose through coughing and sneezing in addition to wearing a surgical mask in case of having a cold or a flu while not mixing in public places.

http://ngha.med.sa/English/MediaCenter/News/Pages/XVAugVI.aspx

Edited August 19, 2015 by niman

niman · August 19, 2015

niman · August 19, 2015

niman · August 19, 2015

Published Date: 2015-08-17 21:42:52
Subject: PRO/AH/EDR> MERS-CoV (108): Saudi Arabia, RFI
Archive Number: 20150817.3584526

MERS-COV (108): SAUDI ARABIA, REQUEST FOR INFORMATION
*****************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Saudi Arabia - MOH 13-17 Aug 2015, RFI
[2] Saudi Arabia - MOH press release - 17 Aug 2015, RFI
[3] Saudi Arabia - MOH press release - 16 Aug 2015

******
[1] Saudi Arabia - MOH 13-17 Aug 2015, RFI
Date: 17 Aug 2015
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx?PageIndex=1

[Sincere apologies for delays in some of this information due to serious technical difficulties (personal computer issues). - Mod.MPP]

As of noon today, 17 Aug 2015, there have been a total of:
1105 laboratory confirmed cases of MERS-CoV infection, including
479 deaths,
590 recoveries, and
36 currently active cases including 3 on home isolation.

Daily changes in case counts since the last update include:
17 Aug 2015
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-08-17-001.aspx
9 newly confirmed cases - all in Riyadh, 1 healthcare worker, 4 in critical condition, 5 stable, all with history of contact with other known case(s)
2 newly reported fatalities - both in Riyadh, both with history of co-morbidities
1 newly reported recovery - in Riyadh, history of co-morbidities

16 Aug 2015
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-08-16-001.aspx
4 newly confirmed cases - 3 in Riyadh, in Najran (Expat - healthcare worker, denies contact with other known cases), 1 noted to be fatal at time of report, 3 stable, 3 with possible history of contact with other case(s) under review (all 3 from Riyadh),
2 newly reported fatalities - 1 in Riyadh (newly reported case), 1 in Abha
1 newly reported recovery - in Riyadh

15 Aug 2015
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-08-15-001.aspx
1 newly confirmed case - in Riyadh, possible history of contact with other known case(s) under review
0 newly reported fatalities and
0 newly reported recoveries

14 Aug 2015
http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-08-14-001.aspx
4 newly confirmed cases - all in Riyadh, includes 2-year-old child, 3 cases with history of contact with other known case(s), all stable
1 newly reported fatality - in Riyadh, history of co-morbidities
0 newly reported recoveries

13 Aug 2015 [in Arabic]
http://www.moh.gov.sa/ccc/pressreleases/pages/statistics-2015-08-13-001.aspx
1 newly confirmed case - in Riyadh, in critical condition, possible history of contact with other known case(s) under review
0 newly reported fatalities
0 newly reported recoveries

[reported case fatality rate 43.3 percent]

--
Communicated by:
ProMED-mail
<[email protected]>

[There is clearly a major outbreak ongoing in Riyadh that appears to have started around 21 Jul 2015. Since 21 Jul 2015, there have been a total of 58 cases of MERS-CoV reported by Saudi Arabia of which 53 (91.4 percent) were from Riyadh. Since the beginning of August 2015, there have been a total of 48 cases reported in Saudi Arabia of which 45 cases (93.8 percent) were from Riyadh. I refer readers to section [2] below where the Saudi Press Agency report from the MOH discusses the ongoing outbreak in the King Abdul Aziz Medical City, involving exposures in the Emergency Department, other Outpatient Departments, and on the hospital wards, with overcrowding, including of outside visitors, and reduced isolation capabilities in these areas. It does appear as though the outbreak has been escalating, with the identification of 9 newly confirmed cases in the past 24 hours and the identification of 27 new cases in the past week.

Of note is that on 16 Aug 2014 there was a single case in a healthcare worker from Najran who denied history of contact with known cases of MERS-CoV in the 2 weeks prior to onset of illness. It is noteworthy because on 4 Aug 2015 there was another case in a healthcare worker from Najran who also denied a history of contact with known case of MERS-CoV in the 2 weeks prior to onset of illness. One wonders if there is ongoing transmission in Najran that is being missed. ProMED-mail would greatly appreciate more information on the situation in Najran.

A map showing the locations of the newly reported cases can be found at the source URL above. The HealthMap/ProMED-mail map of Saudi Arabia can be found at http://healthmap.org/promed/p/131. - Mod.MPP]

******
[2] Saudi Arabia - MOH press release, 17 Aug 2015, RFI
Date: 17 Aug 2015
Source: SPA - Saudi Press Agency [machine translation, edited]
http://www.spa.gov.sa/details.php?id=1388728&lite=

On [17 Aug 2015], the Preventive Medicine Management and Infection Control and Health Affairs at the Ministry of National Guard revealed the existence of 31 MERS-CoV infected individuals at the King Abdul Aziz Medical City in Riyadh, associated with patients who visited the Emergency Medicine departments in addition to 4 cases among healthcare practitioners during the period June 2015 through [14 Aug 2015].

The Executive Director of the Department of Preventive Medicine and Infection Control and Health Affairs at the Ministry of National Guard [Dr. Hanan?] and a Member of the National Scientific Committee of Infectious Diseases at the Ministry of Health and the National team member explained that there is an ongoing epidemiology and infectious diseases investigation. They have been monitoring the number of suspected cases during the past 48 hours, and, currently, all the clinical and laboratory tests needed to follow their health status [have been] conducted. [To date - 14 Aug 2015] there have been 12 fatalities [associated with this outbreak]. This type of respiratory virus is the most deadly to those who suffer from chronic diseases such as diabetes, stress and failure kidney.

Dr. Hanan reported that affected healthcare workers have not included fatalities, and the majority of them have been under home isolation.

[Dr. Hanan] said: "Because of the latest developments about the increasing number of cases of MERS-CoV infection, and due to the large daily congestion [24/7] in the emergency medicine departments of King Abdulaziz Medical City in Riyadh, and the difficulty of isolation [of patients] in these overcrowded sections, the National Guard has implemented strict measures to reduce the number of patients in the emergency departments and outpatient clinics as well as to stop the operations of non-emergency and urgent care. In addition, there have been 3 isolation wings in the hospital designated to accommodate suspected and confirmed cases [of MERS-CoV infection] [suspected and confirmed in separate or the same wings? - Mod.MPP] and the allocation of an intensive case unit to accommodate and isolate those cases in critical condition as well as reducing and limiting visiting hours and the number of visitors.

Dr. Hanan stressed that they emphasized that healthcare practitioners consistently adhered to infection control measures according to internationally established standards, policies and procedures recommended by the Command and Control Center [CCC] at the Ministry of Health, since they [healthcare workers] are the most vulnerable to infection as a result of contact with infected patients, indicating that the epidemiology plan will be evaluated on a daily basis and adjusted according to the need for new developments.

Dr. Hanan showed that it is recorded that infected cases of MERS-CoV came from various health sectors and were presenting on a daily basis to the Ministry of Health system, and there was communication with the Command and Control Center at the Ministry of Health continuously in order to activate the procedures to be followed at the national level to fight infection and reduce the spread of infectious diseases. [Dr. Hanan] confirmed that the Ministry of Health of the National Guard Affairs was dealing with the current situation with complete transparency and high professional norms in the ongoing cooperation between them and the Ministry of Health and the concerned authorities.

[Dr. Hanan] noted the importance of active cooperation by patients and clients and visitors to the civilian King Abdulaziz Medical City in Riyadh by following the awareness tips that are distributed across publications and presented through visual aids in the majority of media channels and social networking sites on the avoidance of going to emergency departments, except in critical situations or injuries that require ambulatory procedures, in addition to the reduction of visits to [hospitalized] inpatients as much as possible, and a commitment to apply the correct ways to avoid the spread of droplets caused by coughing and sneezing, as well as being careful to wear a mask in case of colds or flu and not mixing in public places.

--
Communicated by:
ProMED-mail
<[email protected]>

[Reading the above press release is a deja vu of the press releases surrounding the outbreak in South Korea; it appears as though there has been significant transmission of the MERS-CoV in the emergency departments [EDs], outpatient departments [OPDs] and among visitors to individuals originally admitted to the hospital for other reasons. So a question that arises is have they (the public health system) in Riyadh identified superspreaders in this ongoing outbreak, similar to those identified in the recent outbreak in South Korea, and given the recent experience in South Korea, are we now seeing more superspreaders than in earlier outbreaks in 2012, 2013 and 2014? Has the virus changed? Or has the virus been "lucky" in finding the perfect storm situations and taking advantage of them (overcrowding of healthcare institutions with prolonged exposure in EDs, OPDs, and crowded hospital wards with multiple patients in rooms and multiple visitors in quasi residence with their hospitalized family members)?

ProMED-mail would welcome information on the ongoing epidemiologic investigations in Riyadh from knowledgeable individuals in the area. - Mod.MPP]

******
[3] Saudi Arabia - MOH press release - 16 Aug 2015
Date: 16 Aug 2015
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2015-08-16-001.aspx

MOH: "21 MERS-CoV Cases Reported Last Week" [16 Aug 2015]
-----------------------------
In its weekly press release, the Ministry of Health (MOH) announced that 20 confirmed cases of the Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported in Riyadh and another case in Abha last week, from [9-15 Aug 2015], corresponding to Shawwal 24th to 30th, 1436H (the 33rd International Week).

"During the same period, 844 samples were tested for coronavirus at the MOH laboratories across the Kingdom, including 5 cases at the MOH hospitals and 16 other cases at the other health sectors. The total number of visits by public health teams to persons in contact with positive cases was 21," the Ministry said, adding that the number of persons who were in contact with positive cases at homes was 119, and the number of visits by the Ministry of Agriculture (MOA) was one.

The Ministry also announced that 588 cases out of the total of 1092 confirmed cases have been cured, at a rate of 54.8 percent. There are 25 other cases still receiving treatment, and 4 cases have been isolated at home.

The Command and Control Center (CCC) keeps up its efforts around the clock by carrying out epidemiological surveillance tasks, making sure that all governmental and private health facilities abide by infection control measures, as well as coordinating with the relevant governmental sectors, international health organizations, including the World Health Organization (WHO), and think-tanks to follow up on all developments regarding coronavirus. Over and above, the Ministry keeps up its efforts and full coordination with the Ministry of Agriculture (MOA) to launch anti-coronavirus awareness campaigns at gathering places of camels to urge camel owners and shepherds to be careful and take protective measures when dealing with camels. Finally, the MOH highlighted that it will remain committed to the preset preparations and cooperative efforts with other parties, including the Saudi community and healthcare staff, who represent the cornerstone in this regard.

--
Communicated by:
ProMED-mail
<[email protected]>

[The above overview of the week's experience demonstrates the intensive screening effort that has gone on (844 specimens were tested for evidence of MERS-CoV infection, and 21 cases were confirmed during the 7-day period from 9-15 Aug 2015).

On an additional note, the situation in South Korea remains unchanged, with no new cases reported since 4 Jul 2015 and one individual still reported as not being MERS-CoV negative. (http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=1&CONT_SEQ=324855). - Mod.MPP]

SAUDI ARABIA IS ON THE CUSP OF ANOTHER MERS OUTBREAK

IN THE LAST 24 hours, Saudi Arabia’s Ministry of Health has reported ten new cases of MERS in the capital city of Riyadh, and one death from the virus. Those numbers follow reports of nine new cases yesterday, along with two deaths. According to Helen Branswell, one of WIRED’s favorite infectious disease reporters, the state hasn’t seen that many new infections in a day since theheight of the MERS outbreak last year.

This is especially concerning as travelers begin to arrive for the hajj, the annual pilgrimage to Islam’s holy sites that falls between September 20 and 25 this year. Over the course of the pilgrimage, Saudia Arabia hosts more than 2 million people, who sleep in hot shared tents and travel barefoot toward their destinations. Those conditions make it extraordinarily easy for a virus like MERS to spread—especially devastating because MERS kills about 50 percent of the people it infects. The country has not yet posted itshealth regulations for 2015 hajj travelers.

http://www.wired.com/2015/08/saudi-arabia-may-cusp-another-mers-outbreak/

niman · August 19, 2015

By ABDULLAH AL-SHIHRI6 hours ago

RIYADH, Saudi Arabia (AP) — Saudi authorities closed an emergency ward in one of the kingdom's largest hospitals after at least 46 people, including hospital staff, contracted the potentially fatal Middle East respiratory syndrome, also known as MERS, a health official said Wednesday.

Dr. Hanan Balkhi of the Health Ministry's department for infectious diseases said that of the 46 people infected at King Abdulaziz Medical City in the capital, Riyadh, 15 were medical staff. Another 20 people showing symptoms are being tested, she added.

The patients from the ward, set to remain closed for two weeks, are being transferred to other hospitals, she said.

The Health Ministry recorded three new MERS deaths in Riyadh on Wednesday. The victims were all Saudi males ranging in age from 65 to 86, according the ministry's website. That brings the total number of deaths to 483 since the virus was first identified in 2012.

The ministry said that 1,118 cases have been registered nationwide; 592 have recovered and the rest — 43— are being treated. It appears the three who died are from among the 46 people diagnosed with MERS at the emergency ward that was closed.

Most MERS cases have been diagnosed in the Middle East, primarily in Saudi Arabia. The MERS virus belongs to the family of viruses known as coronaviruses, which include both the common cold and SARS, or severe acute respiratory syndrome. SARS killed some 800 people in a global outbreak in 2003.

The MERS virus can cause symptoms such as fever, breathing problems, pneumonia and kidney failure.

___

This story has been corrected to show Saudi officials issued statements Tuesday and Wednesday about the disease.

http://news.yahoo.com/saudi-closes-emergency-ward-spike-mers-virus-cases-092008088.html

niman · August 19, 2015

niman · August 19, 2015

niman · August 20, 2015

niman · August 20, 2015

niman · August 21, 2015

Ten new Riyadh MERS cases as hospital ED shuttered

Lisa Schnirring | News Editor | CIDRAP News

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Aug 20, 2015

The number of MERS-CoV cases in Riyadh's outbreak climbed by 10 today, as Saudi Arabia's Ministry of Health (MOH) made its first statement about a hospital-linked outbreak, which said the facility's emergency department (ED) has been closed to curb the spread of the virus.

The MOH has now confirmed 69 MERS-CoV (Middle East respiratory coronavirus) cases in Riyadh this month.

Looking at another aspect of the MERS threat, the agency also said sacrifices involving camels—thought to be a reservoir for the virus—will be prohibited in connection with Hajj religious rituals later this year.

Two more deaths reported

All 10 of the new cases reported today in the Saudi MOH's regular update involve Saudi citizens from Riyadh, and authorities are probing exposure sources for all of them. Though the MOH doesn't specify if they are linked to an outbreak at the city's King Abdulaziz Medical City, in weighing in on the event a few days ago the facility said several more suspected cases were under evaluation.

One of the patients included on today's list of new cases is a healthcare worker, a 59-year-old woman who is listed in stable condition.

One case, that of a 35-year-old man who had an underlying health condition, proved fatal. The MOH also announced the death of a previously reported patient from Riyadh, a 71-year-old man who also had a preexisting medical condition.

All of the latest lab-confirmed patients are adults, ranging in age from 34 to 87 year old. Two are hospitalized in critical condition, and seven are listed as stable.

According to the MOH, 48 people are still being treated, and three are in home isolation.

Cases reported today boost the country's overall total from MERS-CoV to 1,128 infections, 485 of them fatal. So far 592 people have recovered.

MOH notes hospital outbreak

The country's health ministry yesterday acknowledged the hospital link in the Riyadh outbreak in a statement in Arabic on its Web site, picked up and translated by Avian Flu Diary, an infectious disease news blog.

The MOH said the spread of the virus was relatively limited to one source and that the hospital's ED is closed. It added that authorities are meeting with hospital officials and have plans to be transparent about the outbreak with the public and the media.

The statement said that health minister Khalid Al Falih held a press conference, at which he said more cases are likely to be reported and that the virus could spread to other facilities. With the hospital's ED closed, the current focus is on limiting contacts and isolating suspected and confirmed cases.

MOH advised the public not to worry and added that school closures and activity bans aren't warranted. It added that people should follow basic hygiene procedures and observe precautions when visiting hospitals.

Also, officials said the country had experiences similar outbreaks before, and that strict application of MOH-recommended infection control steps has stemmed them in the past and will be useful in curbing the current outbreak.

Camel restriction

In a separate development reported in the Arabic language media, also translated and posted by Avian Flu Diary, the MOH yesterday announced a ban on sacrificing camels as part of Islamic Hajj rituals this year. The Hajj starts Sep 25 in Saudi Arabia.

As part of the pilgrimage, each person must sacrifice or pay for part of the sacrifice of a sheep, goat, cow, or camel. The cooked meat is then shared with the poor.

Camels are thought to harbor the virus, and health officials suspect that sporadic zoonotic transmission plays a role in fueling MERS-CoV transmission in the Middle East, especially in Saudi Arabia, the hardest-hit country.

Experts monitor developments

Peter Ben Embarek, PhD, who heads the MERS-CoV response for the World Health Organization, spotlighted the ED closure and added that new cases are being reported daily, ones that were detected some time ago.

Earlier this week he said global health officials are in close contact with Saudi Arabia's health officials and that support options were under discussion, including the possibility of a joint mission.

Maria Van Kerkhove, PhD, an epidemiologist with the Pasteur Institute Center for Global Health in Paris, has been part of past joint missions to investigate MERS outbreaks in Saudi Arabia and South Korea. She said the characteristics of nosocomial outbreaks in Saudi Arabia and elsewhere are unfortunately similar. Common factors include overcrowding, poor infection control, and lack of awareness that can amplify transmission in hospital settings, she said.

"Saudi Arabia has the tools and knowledge to tackle and stop nosocomial outbreaks, including this outbreak in Riyadh," Van Kerkhove added.

See also:

Aug 20 Saudi MOH statement

Aug 19 Avian Flu Diary post on Saudi MOH hospital outbreak statement

Aug 20 Avian Flu Diary post on Hajj camel sacrifice ban

http://www.cidrap.umn.edu/news-perspective/2015/08/ten-new-riyadh-mers-cases-hospital-ed-shuttered

niman · August 21, 2015

niman · August 21, 2015

Admin · August 22, 2015

MERS sickens six more in Riyadh outbreak

Lisa Schnirring | News Editor | CIDRAP News

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Aug 21, 2015

The total in a MERS-CoV outbreak in Riyadh grew by six today—including a 109-year-old man—as the hospital linked to many of the cases announced new steps to curb the outbreak.

Newly announced Middle East respiratory syndrome coronavirus (MERS-CoV) confirmations from Saudi Arabia's Ministry of Health (MOH) boost the number of cases reported since Jul 21 in Riyadh to 81.

New case details

In its daily update today, the Saudi MOH said five of the six patients had contact with a suspected or confirmed case in the community or hospital, suggesting that they could be part of an outbreak at Riyadh's King Abdulaziz Medical City.

The 109-year-old man is hospitalized in stable condition, as are the other five patients.

One of the new confirmed cases is a 40-year-old woman who is healthcare worker from outside of Saudi Arabia.

Others include three men, ages 87, 72, and 71 years old, and a 58-year-old woman who apparently didn't have contact with an earlier case.

In addition to the new cases, the MOH reported one death in a previously announced case-patient from Riyadh, an 86-year-old man who had underlying health conditions.

The MOH said 52 people are still being treated for their infections, and 4 more are in home isolation.

Today's additional cases lift Saudi Arabia's overall total from the disease, first detected in 2012, to 1,134, which includes 486 deaths. So far 592 people have recovered from their infections.

Hospital response update

King Abdulaziz Medical City said today in Twitter posts that it had postponed most outpatient appointments scheduled for Aug 23 and Aug 24 to curb spread of the virus. The only exceptions are for chemotherapy, obstetrics, and valve replacement clinics.

A specialty children's hospital that is part of the medical city will continue with business as usual, with no cancelled clinics or admissions.

It said the Saudi MOH will continue to publish the number of positive MERS-CoV cases.

Earlier this week the hospital announced that since June, 31 illnesses had been linked to visits to its emergency department, a pattern seen in a recent MERS-CoV outbreak in South Korea. It also said several more illnesses were suspected.

Global health officials are discussing the possibility of a joint World Health Organization mission to help the country investigate the outbreak.

See also:

Aug 21 Saudi MOH statement

National Guard Hospital Twitter feed

http://www.cidrap.umn.edu/news-perspective/2015/08/mers-sickens-six-more-riyadh-outbreak

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