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 Post subject: Re: 9 MERS Cases UAE
PostPosted: Wed Apr 23, 2014 5:53 am 
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Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News

23 APRIL 2014 - On 21 April 2014, 18 April 2014 and 16 April 2014, the Ministry of Health of the United Arab Emirates (UAE) reported an additional 9 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO on 21 April 2014 by the Ministry of Health UAE:
A 52 year-old woman from Abu Dhabi. She became ill and was admitted to a hospital on 16 April. She has underlying medical conditions and is currently in a stable condition. The patient travelled to Jeddah, Saudi Arabia from 5-16 April, where she visited the hospital 3 times. She has no history of contact with animals. All her contacts are being investigated.
The following details were provided to WHO on 18 April by the Ministry of Health UAE:
A 63 year-old woman from Abu Dhabi who had close contact with a previously laboratory-confirmed case reported on 14 April. She was screened on 13 April and became ill on 15 April. She is reported to have an underlying medical condition. She is reported to have no exposure to animals or a recent travel history.
A 73 year-old woman from Abu Dhabi who has been an in-patient at the hospital since 26 February due to other illnesses. She has underlying medical conditions. The patient was admitted to the intensive care unit (ICU) on 14 April. She is reported to have no exposure to animals or a recent travel history.
Globally, from September 2012 to date, WHO has been informed of a total of 253 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

Case totals published in the Disease Outbreak News on MERS-CoV on 20 April 2014, already included the 6 laboratory-confirmed cases reported from the UAE on 16 April, 2014 below.

The following details were provided to WHO on 16 April 2014 by the Ministry of Health UAE:
All the cases are from Abu Dhabi and have had close contact with a laboratory-confirmed case reported on 10 April. To date, the cases are kept in isolation in a hospital and are well. Screening of other health care contacts and family members are ongoing.

A 52 year-old woman who had mild illness on 9 April and was screened on 10 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 28 year-old who was screened on 10 April. He has no illness and is reported not to have any underling medical condition and does not have exposure to animals or a recent travel history.
A 59 year-old man who was screened on 12 April. He has no illness. He is reported to have an underlying medical condition. He is reported not to have exposure to animals or a recent travel history.
A 28 year-old man who was screened on 10 April. He developed mild illness on 11 April. He is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 55 year-old woman who was screened on 12 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 28 year-old woman who was screened on 10 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) 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. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all 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.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

http://who.int/csr/don/2014_04_23_mers/en/

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 Post subject: Re: 9 MERS Cases UAE
PostPosted: Wed Apr 23, 2014 8:19 pm 
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WHO office sounds alarm as MERS cases push higher

Lisa Schnirring | Staff Writer | CIDRAP News | Apr 23, 2014

Against the backdrop of 33 more Middle East respiratory syndrome coronavirus (MERS-CoV) cases reported by Saudi Arabia—some in Mecca—and the United Arab Emirates (UAE), the World Health Organization (WHO) today raised concerns about the ongoing spike in cases, especially in healthcare settings, and offered to help the countries pull together a global team to help investigate and assess the risks.

The WHO aired the issues in a press release that its Eastern Mediterranean office (EMRO) in Cairo e-mailed to journalists. The statement came amid two separate announcements of cases from Saudi Arabia's health ministry—one reporting 11 new cases and the other reporting 13 new illnesses, two of them fatal, along with two other deaths. In addition, WHO headquarters in Geneva announced details about nine MERS-CoV cases that it received from the UAE on April 16, 18, and 21.

The statements from Saudi Arabia included details about the first cases reported in the holy city of Mecca, including one in a Turkish pilgrim.

WHO offers assistance
Ala Alwan, MD, EMRO's director, said in the statement that 75% of recently reported infections are secondary cases, considered to have been spread from other people. "The majority of these secondary cases have been infected within the healthcare setting and are mainly healthcare workers, although several patients are also considered to have been infected with MERS-CoV while in hospital for other reasons," he added.

Underscoring WHO EMRO's concerns about illness links to health settings, three of Saudi Arabia's MERS-CoV case-patients reported today are healthcare workers, two from Jeddah and one from Riyadh. Also, two of the UAE patients had hospital exposure: one while visiting a facility and the other a patient who had been hospitalized since late February for another medical condition.

Among other common threads in today's cases, 17 had underlying medical conditions, and 10 are listed as contacts of other confirmed cases. Most of the patients who had known contact with a lab-confirmed case-patient have no symptoms or only mild symptoms.

WHO EMRO said that though most of the cases involve asymptomatic or mild infections and don't spread the virus to others, key information gaps remain about the transmission of the virus and the route of infection. One of the unanswered questions is the type of exposure in healthcare settings that transmit the virus.

Therefore, the WHO is offering to gather international expertise to help the two countries probe the recent outbreaks to identify the transmission chain in the clusters and if the pattern signals any new risks.

The WHO also raised concerns about a fresh round of MERS-CoV infections in people who visited Saudi Arabia or the UAE, as recent cases were reported in Greece, Jordan, Malaysia, and the Philippines. It said that though no further spread of the virus has been linked to those cases, earlier imported cases in France and the United Kingdom resulted in limited human-to-human spread.

It urged nations to stay vigilant and enhance surveillance to detect any sign that the virus has changed in a way that makes it more transmissible among humans.

Saudi Arabia reports 24 cases
Saudi Arabia said today in its first statement (posted in English on the health ministry's web site) that four of the 11 case-patients reported today are from Riyadh, six are from Jeddah, and one is from Mecca. All 11 of the cases are residents of Saudi Arabia. Ten are adults, ranging in age from 24 to 81 years old. One is a 13-year-old Jeddah resident, a contact of a previous case, who is asymptomatic.

Of the 11 patients, eight are being treated in intensive care units (ICUs), two are listed in stable condition, and one is asymptomatic. Three of the patients are healthcare workers.

Later today the health ministry announced 13 more cases, according to a machine translation of a statement posted in Arabic. Five cases are reported from Riyadh, two from Jeddah, four from Mecca, one from Medina, and one from Jordan, which appears to be an imported case from Saudi Arabia.

The statement contained several details about the cases that haven't typically been included in past ministry statements, such as hospitalization locations and dates, which underlying medical conditions they have, and if they have pneumonia and are on respirators. It's not clear if the added details in the latest statement are the result of the country's recent change in health ministers. Earlier in the week Saudi Arabia reassigned its health minister and appointed labor minister Adel bin Mohammad Faqih as acting health minister.

One of the patients is a 65-year-old pilgrim from Turkey who is hospitalized in stable condition in Mecca.

Two deaths were reported among the 13 new cases: an 80-year-old man with several underlying medical conditions who died at a Riyadh hospital on Apr 22 and a 52-year-old who was hospitalized in Mecca and also died on Apr 22. Saudi Arabian officials also reported two other deaths in presumably previously confirmed cases, which include a 45-year-old health worker from Al-Kharj governorate who died on Apr 21 and a 29-year-old who died at King Fahd Hospital in Jeddah on Apr 22.

Five of the patients are hospitalized at a military hospital in Riyadh, one is at King Faisal Specialist Hospital in Jeddah, one is hospitalized in Medina, one at a security force hospital in Mecca, and three apparently at another hospital in Mecca.

Of the 13 cases, two patients died, three are on respirators, three are being treated in ICUs, four are stable, and one is asymptomatic. Hospitalization dates, listed for 10 of the patients, range from Mar 27 through Apr 21.

Patient ages range from 13 to 88, though most are middle-aged and older adults.

MERS sickens nine more in UAE
Details about the nine cases in the UAE were included in a statement today from the WHO. All of the patients are adults from Abu Dhabi, ranging in age from 28 to 73 years old. One is a 52-year-old woman who got sick after traveling to Jeddah in Saudi Arabia from Apr 5 through Apr 16, where she visited the hospital three times. One of the others is a 73-year-old woman who had been hospitalized since Feb 26 for another medical condition and was admitted to the ICU on Apr 14.

Six of the UAE cases, all reported to the WHO on Apr 16, had close contact with a lab-confirmed case that was reported on Apr 10. Three are women and three are men. Four had mild illnesses and two were asymptomatic. Only one of them had an underlying medical condition.

With the flurry of recent new cases and lack of clarity in some of the recent health ministry statements, the outbreak total is unclear. FluTrackers, an infectious disease news message board, maintains a running list of lab-confirmed MERS-CoV cases, along with an updated overall case count. However, it said today that some of the cases appear to have already been reported, such as that of a 52-year-old UAE woman reported today, and that as of today it will no longer track the overall count, though it will continue to provide daily case totals.

The WHO said today in the EMRO statement that it has received reports of 253 lab-confirmed cases, including 93 deaths. FluTrackers, in its last case count, said there were 364 cases reported by health ministries. Meanwhile, Saudi Arabia's health ministry said today that it has now recorded 285 infections from MERS-CoV, 83 of them fatal.

See also:

Apr 23 Saudi Arabian health ministry statement in English on 11 cases

Apr 23 WHO EMRO press release

Apr 23 Saudi Arabian health ministry statement in Arabic on 13 cases

Apr 23 WHO statement

Saudi Arabian health ministry main media page

Apr 21 CIDRAP News story "Saudi Arabia sacks health chief as MERS cases surge"

http://www.cidrap.umn.edu/news-perspect ... ush-higher

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 Post subject: Re: 9 MERS Cases UAE
PostPosted: Fri Apr 25, 2014 5:17 pm 
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Posts: 49047
Location: Pittsburgh, PA USA
Published Date: 2014-04-24 22:07:16
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, UAE, Jordan ex KSA, WHO, RFI
Archive Number: 20140424.2424017

MERS-COV - EASTERN MEDITERRANEAN (40): SAUDI ARABIA, UAE, JORDAN ex SAUDI ARABIA, WHO, 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, 12 new cases, 2 deaths, MOH 24 Apr 2014
[2] Saudi Arabia, 11 new cases, MOH 23 Apr 2014, RFI
[3] Saudi Arabia, 13 new cases, 2 deaths MOH 23 Apr 2014
[4] UAE, 9 new cases - WHO 23 Apr 2014
[5] Jordan ex Saudi Arabia - WHO 24 Apr 2014
[6] MERS-CoV risk assessment - WHO 24 Apr 2014
[7] Greece ex Saudi Arabia -ECDC update - 23 Apr 2014

******
[1] Saudi Arabia, 12 new cases, deaths, MOH 24 Apr 2014
Date: 24 Apr 2014
Source: Saudi MOH [In Arabic, mach trans. edited]
http://www.moh.gov.sa/CoronaNew/PressRe ... 4-001.aspx


MOH: recorded 12 new cases of infection with MERS-CoV recorded - 24 Apr 2014
-----------------------------
Daily situation report on cases of MERS-CoV infection
[Thurs., 24 Apr 2014 ]
- The total number of confirmed cases within 24 hours: 12 cases
- The total number of deaths within 24 hours: 2

Distribution of cases on the cities of the Kingdom :
Riyadh: 5 cases
Jeddah: 6 cases
Mekkah: 1 case

A summary of the health status of cases:
1 case without symptoms
6 cases in stable condition and receiving treatment in the hospital
5 cases in intensive care

Distribution of cases in hospitals within the Kingdom:
Prince Sultan Medical City in Riyadh Military
- 2 stable citizens
- 1 case without symptoms (a nurse)

Security Forces Hospital in Riyadh
-1 case a citizen in critical condition

King Saud Hospital for Chest Diseases in Riyadh
- 1 case a citizen in stable condition

King Fahd Hospital in Jeddah
- 1 case in a resident who is a doctor and is in stable condition
- 1 case in a citizen in critical condition

King Saud Hospital in Jeddah
- 1 case in a resident who is in critical condition

Bakhsh Hospital in Jeddah
- 1 case in a resident who is in critical condition
- 1 case in a resident who is in stable condition.

Hospital doctors Challengers [? actual name of the hospital] in Jeddah
- 1 case in a resident in critical condition

Al Noor Hospital in Mekkah
- 1 case in a nurse in stable condition.
​ ​
Details of the cases:
A - in the city of Riyadh:
- 1. Male citizen at the age of 79 years is suffering from leukemia and cancer of the prostate security forces entered the hospital on [1 Apr 2014] complaining of abdominal pain, and developed respiratory symptoms after a week of hospitalization [?], and receiving treatment in the intensive care unit on an artificial respiratory system.
- 2 . Filipina nurse nationality at the age of 40 years working in the cardiac unit at the hospital for the military contact with a confirmed case, do not show symptoms
- 3. Male citizen at the age of 76 years suffering from diabetes, high blood pressure, previous stroke, he entered the military hospital on [1 Apr 2014] with symptoms of pneumonia and fluid in the lungs and the suspicion he was diagnosed with tuberculosis and was found negative for tuberculosis, and on 21 Apr 2014 respiratory symptoms worsened at which time tests for MERS-CoV were positive. Patient is in stable condition, receiving treatment in the ward.
- 4. Citizen at the age of 62 years old, suffers from high blood pressure entered the military hospital on [21 Apr 2014] with respiratory symptoms, and is in stable condition receiving treatment in the hospital.
- 5. Citizen at the age of 44 years old, entered the King Saud Hospital for Chest Diseases on [21 Apr 2014] with respiratory symptoms, and in stable condition and receiving treatment in the suite [?intensive care unit vs isolation room].

B - in Mekkah:
- 1. Filipina nurse nationality at the age of 34 years, and working in a hospital intensive care unit in Mekkah, had known contact with a confirmed case, and developed respiratory symptoms on [21 Apr 2014] and is receiving treatment in the hospital and is in stable condition.

C - in the province of Jeddah:
- 1. A Syrian doctor at the age of 51 years working in the intensive care unit at King Fahd Hospital, developed respiratory symptoms on [19 Apr 2014] and is in stable condition and receiving treatment in the suite [?intensive care unit vs isolation room].
- 2. A citizen at the age of 47 years, and entered the King Fahd Hospital with respiratory symptoms on [21 Apr 2014], and receiving treatment in intensive care on a respirator.
- 3. A female resident with Indonesian citizenship at the age of 28 years, she developed respiratory symptoms on [15 Apr 2014] and entered the King Saud hospital on [19 Apr 2014], and is receiving treatment in intensive care on a respirator.
- 4. A resident with Palestinian citizenship at the age of 68 years, developed respiratory symptoms on [20 Apr 2014] and entered the hospital on [22 Apr 2014] and is receiving treatment in intensive care.
- 5. A resident of Egyptian nationality at the age of 47 years old, works in a hospital as a receptionist developed respiratory symptoms on [19 Apr 2014], and is receiving treatment in the hospital and his health condition is stable.
- 6. A resident of Palestinian citizenship at the age of 19 years, developed respiratory symptoms on [15 Apr 2014] and entered the United Doctors Hospital on [18 Apr 2014] and receiving treatment in intensive care.

Deaths within [past] 24 hours:
2 deaths from previously recorded conditions:
- 1) a citizen at the age of 68 in Mekkah
- 2) a Female citizen at the age 72 in Riyadh

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[With the addition of these newly reported cases and the 24 reported cases yesterday (see sections [2] and [3] for more details), the total number of laboratory confirmed cases reported by Saudi Arabia in the past 24 hours is 36 cases including 4 deaths. In the above report, there are 4 cases who worked in the health care environment, nurses (2), doctor (1) and receptionist (1). 7 of the 13 cases are in expatriots presumably living and working in Saudi Arabia (although this is not definitively stated). Nationalities include Philippine, Egyptian, Palestinian and Indonesian.

Riyadh case number 1 mentioned above appears to have gotten the MERS-CoV infection while admitted to the hospital initially for other reasons. This case, together with the cases in healthcare workers suggests that there was (?and still is) significant nosocomial transmission of the MERS-CoV within the healthcare environment in Saudi Arabia, both in Riyadh as well as in Jeddah and Mekkah as all 3 locations seem to have involvement of healthcare workers.

For those apparent index cases (those appearing at the hospital for the 1st time when ill with symptoms compatible with MERS-CoV infection), a case control study addressing possible risk exposures would be helpful. For those with histories of comorbidities, one wonders if there might have been animal exposure, or exposure when seeking health care (non-inpatient/hospitalized healthcare) for their comorbidities.

For a map of Saudi Arabia, see < http://healthmap.org/promed/p/131>. - Mod.MPP]

******
[2] Saudi Arabia, 11 new cases, MOH 23 Apr 2014, RFI
Date: 23 Apr 2014
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/CoronaNew/Pres ... 3-001.aspx


MOH: 11 New Corona Cases Recorded in the Kingdom's Regions - 23 Apr 2014
----------------------------
Within the framework of the constant monitoring and epidemic surveillance of the Middle East Respiratory Syndrome-Corona Virus (MERS-CoV), the Ministry of Health (MOH) has announced that 11 new confirmed cases have been recorded, in addition to 5 other cases of those in contact with confirmed cases of this virus. This has been declared after the National Scientific Committee for Infectious Diseases has reviewed and discussed the results of laboratory tests of the cases.

- The 1st case is an 81-year-old male citizen in Riyadh, who has been suffering from various chronic diseases. Now, he is at the Intensive Care Unit (ICU), receiving the proper treatment.
- The 2nd case is a 41 year-old female citizen in Riyadh, who has been suffering from various chronic diseases. Her health status is stable. - The 3rd case is a 59 year-old female citizen in Riyadh, who has been suffering from various chronic diseases. Now, she is at the ICU, receiving the proper treatment.
- The 4th case is for a 34 year-old female resident, working at the health sector in Riyadh, who is in contact with a confirmed case. Now, she is at the ICU, receiving the proper treatment.

- The 5th case is a 13 year-old female citizen in Jeddah, who is in contact with a confirmed case, even though she doesn't have any symptoms.
- The 6th case is a 71 year-old male citizen in Jeddah, who has been suffering from various chronic diseases. Now, she is at the ICU, receiving the proper treatment. [gender is unclear in this online version]
- The 7th case is a 67 year-old male resident in Jeddah, who has been suffering from various chronic diseases. Now, he is at the ICU, receiving the proper treatment.
- The 8th case is a 45 year-old male citizen, working at the health sector in Jeddah. Now, he is at the ICU, receiving the proper treatment.
- The 9th case is a 55 year-old male citizen in Jeddah, who has been suffering various chronic diseases. Now, he is at the ICU, receiving the proper treatment.
- The 10th case is a 24 year-old male citizen in Makkah. His health status is stable.
- The 11th case is a 48 year-old female citizen, working at the health sector in Jeddah. Now, he is at the ICU, receiving the proper treatment. [gender is unclear in this online version]

Stemming from the MOH's keenness to provide all community members, mass media and users of social networking websites with health guidelines and medical tips on the Middle East Respiratory Syndrome-Corona Virus (MERS-CoV), as well as briefing them on its updates, the Ministry calls upon everyone to visit the Coronavirus website on the MOH Portal: www.moh.gov.sa/coronanew, or communicate via the toll free number: 8002494444, 937 call center, or Twitter @SAUDIMOH. Finally, the Ministry of Health wishes all people health and safety.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[There is mention of 11 newly confirmed cases of MERS-CoV infection, and "5 other cases" of those in contact with other confirmed cases. Geographic distribution of the cases: Riyahd (4), Jeddah (6), Mecca (1). Of these 11 cases, 8 are in intensive care therapy, 2 are in stable condition and one is an asymptomatic infection in an individual with known contact with other known MERS-CoV infected individuals. Other notable variables include there were 3 cases who worked in the health field, and 6 of the cases had a history of "various chronic diseases".

The mention of "5 other cases" who had known contact with other confirmed MERS-CoV infected individuals is curious. As the tally of the number of confirmed cases of MERS-CoV infection was not increased accordingly to include another 5 cases, one wonders if this statement refers to an additional 5 known contacts who are symptomatic but testing results aren't back as yet. ProMED would greatly appreciate clarification from knowledgeable sources in Saudi Arabia.

For a map of Saudi Arabia, see < http://healthmap.org/promed/p/131>. - Mod.MPP]

******
[3] Saudi Arabia, 13 new cases, 2 deaths - MOH
Date: 23 Apr 2014
Source: Saudi MOH [edited]
http://www.moh.gov.sa/CoronaNew/PressRe ... 3-002.aspx


MOH: 13 New MERS-CoV Cases Recorded in the Kingdom's Regions - 23 Apr 2014
----------------------------
The total number of the confirmed cases has recently reached 13 cases.

Distribution of corona cases according to the Kingdom's regions:
- 5 cases in Riyadh.
- 2 cases in Jeddah.
- 4 cases in Makkah.
- 1 case in Madinah.
- A Saudi case hospitalized in Jordan, as reported by the representative of the World Health Organization (WHO).

Distribution of the cases according to the Kingdom's hospitals:
- 5 cases at the Military Hospital in Riyadh.
- 1 case at King Faisal Specialist Hospital in Jeddah
- 1 case at Ohud Hospital in Madinah.
- 1 case at Ohud Hospital in Madinah.
- 1 case at Security Forces Hospital in Makkah.
- 3 cases at Al-Noor Hospital in Makkah.

The Health status of the cases:
- 1 case hasn't developed any symptoms.
- 3 stable hospitalized cases.
- 1 stable case in Jordan.
- 6 cases at the ICUs.
- 2 deaths.

Details of the cases:
- The 1st case is an 80 year-old male citizen, who had been suffering from diabetes, hypertension, chronic renal failure and blood cancer. He had been admitted to the Military Hospital in Riyadh on [28 Mar 2014], then passed away on [22 Apr 2014].
- The 2nd case is for a 69 year-old female citizen, who has been suffering from diabetes and hypertension. She has been admitted to the Military Hospital in Riyadh on [18 Apr 2014], complaining diabetic symptoms in the foot. Then, she was hit by pneumonia, and now she is connected to the artificial respiration at the hospital.
- The 3rd case is a 70 year-old male citizen, who has been suffering from cardiac diseases and chronic lung disease. She has been admitted to the Military Hospital in Riyadh on [4 Apr 2014], suffering from pneumonia. Now he is connected to the artificial respiration at the hospital.
- The 4th case is a 72 year-old female citizen, who has been suffering from diabetes and hypertension. She has been admitted to the Military Hospital in Riyadh on [4 April, 2014], suffering from pneumonia. Now she is connected to the artificial respiration at the hospital.
- The 5th case is a 88 year-old male citizen, who has been suffering from diabetes and hypertension. She has been admitted to the Military Hospital in Riyadh on [27th Mar 2014]. Then, he was hit by pneumonia, and his health status is stable.
- The 6th case is a 41 year-old male citizen in Jeddah, who is in contact with a confirmed case, but he hasn't developed any symptoms.
- The 7th case is a 74 year-old female citizen, who has been suffering from anemia symptoms. She has been admitted to King Faisal Specialist Hospital in Jeddah on [14 April 2014]. Then, she has shown pneumonia on [20 Apr 2014], and now she is at the IC unit, receiving the proper treatment.
- The 8th case is a 46 year-old male citizen. He has been admitted to Security Forces Hospital in Makkah on [21 Apr 2014], complaining respiratory symptoms. Now she is at the ICU, receiving the proper treatment.
- The 9th case is a 68 year-old male citizen. He has been admitted to Al-Noor Hospital in Makkah on [12 Apr 2014]. His sample has proven negative, then it has proven positive on [22 Apr 2014]. Now he is at the IC unit, receiving the proper treatment.
- The 10th case is a 65 year-old male Turkish visitor, performing Umrah. He has been admitted to Al-Noor Hospital in Makkah, complaining respiratory symptoms. His health status is stable.
- The 11th case is a 52 year-old Burmese resident. He has been admitted to Al-Noor Hospital in Makkah on [18 Apr 2014]. He passed away on [22 Apr 2014].
- The 12th case is a 13 year-old male citizen, who has developed respiratory symptoms on [9 Apr 2014]. He has been admitted to Ohud Hospital in Madinah, on [21 Apr 2014]. His health status is stable.
- The 13th case is a 25 year-old male citizen from Al-Qurayyat governorate, who has been reported by the representative of the World Health Organization (WHO). He is still in Jordan and his health status is stable.

Within the same vein, there are 2 deaths for 2 confirmed cases after suspicion, as following:
The 1st case is a 45 year-old male resident, working at the health sector in Al-Kharj, who had been suffering from various chronic diseases. He passed away on [21 Apr 2014].
The 2nd case is a 29 year-old male citizen, who has been infected with the virus from the public. He passed way at King Fahd Hospital in Jeddah, on [22 Apr 2014].

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In this report there were 13 newly confirmed cases of MERS-CoV infection, including 2 deaths in previously reported cases announced by the MOH of Saudi Arabia. Of these 13 cases, 5 were in Riyadh, 2 were in Jeddah, 4 were in Mekkah, 1 was in Medina and 1 was in a Saudi citizen hospitalized in Jordan and reported to the MOH Saudi Arabia by the WHO representative in Jordan (see section [5] below. Further confirmation of nosocomial transmission is seen in the 2nd case mentioned above - the 69 year old female citizen who was hospitalized for diabetic foot issues and after an unspecified amount of time, developed symptoms of pneumonia. It is also seen with the 5th case who was admitted for a stroke and then developed pneumonia and the 7th case who was admitted to the hospital for an anemia evaluation and 6 days after admission developed signs of pneumonia. The 10th and 13th cases above highlight the mobility of the population, where the 10th is a pilgrim from Turkey, and the 13th is a Saudi Citizen seeking health care in neighboring Jordan.

Of the 2 fatal cases reported, 1 was in an individual working in the health sector in Al-Kharj (a fatal case), and the other was in a Saudi from Jeddah with presumed "community acquired" infection.

Al Kharj governorate is located in the central portion of Saudi Arabia 77 kms to the south of Riyadh. It is located in the governorate known as Wadi ad-Dwasir. For a map of the governorate, see http://en.wikipedia.org/wiki/File:Riyad ... orates.png. - Mod.MPP]

******
[4] UAE - 9 new cases, WHO
Date: 23 Apr 2014
Source: WHO Global Alert and Response
http://who.int/csr/don/2014_04_23_mers/en/


Middle East respiratory syndrome coronavirus (MERS-CoV) - update 23 Apr 2014
---------------------------
On [21 Apr 2014, 18 Apr 2014 and 16 Apr 2014], the Ministry of Health of the United Arab Emirates (UAE) reported an additional 9 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO on [21 Apr 2014] by the Ministry of Health UAE:

- A 52 year-old woman from Abu Dhabi. She became ill and was admitted to a hospital on [16 Apr 2014]. She has underlying medical conditions and is currently in a stable condition. The patient travelled to Jeddah, Saudi Arabia from [5-16 Apr 2014], where she visited the hospital 3 times. She has no history of contact with animals. All her contacts are being investigated.

The following details were provided to WHO on [18 Apr 2014] by the Ministry of Health UAE:
- A 63 year-old woman from Abu Dhabi who had close contact with a previously laboratory-confirmed case reported on [14 Apr 2014]. She was screened on [13 Apr 2014] and became ill on [15 Apr 2014]. She is reported to have an underlying medical condition. She is reported to have no exposure to animals or a recent travel history.
- A 73 year-old woman from Abu Dhabi who has been an in-patient at the hospital since [26 Feb 2014] due to other illnesses. She has underlying medical conditions. The patient was admitted to the intensive care unit (ICU) on [14 Apr 2014]. She is reported to have no exposure to animals or a recent travel history.

Globally, from September 2012 to date, WHO has been informed of a total of 253 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

Case totals published in the Disease Outbreak News on MERS-CoV on 20 April 2014, already included the 6 laboratory-confirmed cases reported from the UAE on [16 Apr 2014] below.

The following details were provided to WHO on [16 Apr 2014] by the Ministry of Health UAE:

All the cases are from Abu Dhabi and have had close contact with a laboratory-confirmed case reported on [10 Apr 2014]. To date [23 Apr 2014], the cases are kept in isolation in a hospital and are well. Screening of other health care contacts and family members are ongoing.

- A 52 year-old woman who had mild illness on [9 Apr 2014] and was screened on [10 Apr 2014]. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
- A 28 year-old who was screened on [10 Apr 2014]. He has no illness and is reported not to have any underling medical condition and does not have exposure to animals or a recent travel history.
- A 59 year-old man who was screened on [12 Apr 2014]. He has no illness. He is reported to have an underlying medical condition. He is reported not to have exposure to animals or a recent travel history.
- A 28 year-old man who was screened on [10 Apr2014]. He developed mild illness on [11 Apr 2014]. He is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
- A 55 year-old woman who was screened on [12 Apr 2014]. She developed mild illness on [8 Apr 2014]. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
- A 28 year-old woman who was screened on [10 Apr 2014].. She developed mild illness on [8 Apr 2014]. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) 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. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients - regardless of their diagnosis - in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all 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.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Of the 9 cases described in the WHO report above, only one of the cases had a history of travel outside of Abu Dhabi during the incubation period. This is the 1st case described above -- a 52 year-old female reported on 21 Apr 2014 who had a history of comorbidities, and history of seeking medical care at a hospital in Jeddah 3 times while there. By date of onset of illness, she post-dated the presumed index case in the current nosocomial outbreak as his date of onset was reported as 3 Apr 2014. Of note, none of the cases mentioned in the above WHO report had a history of exposure to animals and all of the cases had contact with either the medical sector in general or specifically with known laboratory confirmed cases of MERS-CoV infection. Clinical expression of the MERS-CoV among these 9 cases included asymptomatic infections (2), mild illness (4), stable condition (1), in intensive care (1) and not mentioned (1).

For a map of the UAE, see http://en.wikipedia.org/wiki/File:Riyad ... orates.png. - Mod.MPP]

******
[5] Jordan ex Saudi Arabia, WHO 24 Apr 2014
Date: 24 Apr 2014
Source: WHO Global Alert and Response
http://who.int/csr/don/2014_04_24_mers/en/


Middle East respiratory syndrome coronavirus (MERS-CoV) - update - 24 Apr 2014
-----------------------------------
On [22 Apr 2014], the Ministry of Health of Jordan reported an additional laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The patient is a 25 year-old man from Al Grayat City, Saudi Arabia. He became ill on [9 Apr 2014], was admitted to a hospital in Saudi Arabia on [10 Apr 2014] and discharged from the hospital on [15 Apr 2014], against medical advice. As his condition did not improve, he sought medical care at another hospital in Zarka City, Jordan on [19 Apr 2014], where he was tested positive for MERS-CoV. The patient has underlying medical conditions and has a history of travel to Abha Mecca and Jeddah, Saudi Arabia from [3 to 8 Apr 2014]. He has history of contact with camels and is also reported to have consumed camel milk.

Globally, from September 2012 to date, WHO has been informed of a total of 254 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The 1st known nosocomial outbreak of MERS-CoV (diagnosed retrospectively) occurred in an ICU in Zarka City, Jordan in April 2012. Given the above description of the clinical course and healthcare seeking behavior of this current case (a Saudi citizen from a bordering area in Saudi Arabia who sought additional medical care in Zarka), one can't help but wonder if the "true" index case of that 2012 outbreak in Zarka was someone who came from Saudi Arabia seeking healthcare in Zarka. If information was available, a retrospective look through hospital records in Zarka might be able to address this question. The history of contact with camels and drinking camel's milk of this case adds to the growing body of circumstantial evidence that there may be a direct association between those events and transmission of the MERS-CoV. A case control study addressing these postulated exposures and development of infection with MERS-CoV would be very helpful in further addressing this in a scientific and statistically pure manner.

Al-Jawf Region (also spelled Al-Jouf) is located in the northernmost part of Saudi Arabia and boarders with Jordan. The capital of the region is Sakakah. The region has 3 governorates - Sakakah, Qurayyat (Al Grayat) and Dumat Al-Jandal. A map of the region can be found at http://en.wikipedia.org/wiki/Al_Jawf_Region.

Qurayyat (also Al Qurayyat or Gurayat) is located 19 miles (30 kms) from the border with Jordan and had a population of 147 550 according to the 2010 census. The market is well known for olives and salt and is widely frequented. (http://en.wikipedia.org/wiki/Qurayyat,_Saudi_Arabia).

Zarka (or Zarqa) Jordan is located in the northeast of Jordan 25 kms from Amman. (for a map of Zarka, see http://en.wikipedia.org/wiki/Zarqa). The distance (by road) from Qurayyat (Al Grayat) to Zarka (Zarqua) is 42 miles. - Mod.MPP]

******
[6] MERS-CoV risk assessment - WHO - 24 Apr 2014
Date: 24 Apr 2014
Source: WHO MERS-CoV Risk Assessment
http://who.int/csr/disease/coronavirus_ ... 4.pdf?ua=1


WHO Risk Assessment - Middle East respiratory syndrome coronavirus (MERS‐CoV) [24 Apr 2014]
----------------------
Summary of available information
Since April 2012, 254 laboratory‐confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS‐CoV) have been reported to WHO, including 93 deaths.

To date [24 Apr 2014], reporting countries in the Middle East include Jordan, Kuwait, Oman, Qatar, Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE); in Europe: France, Germany, Greece, Italy and the United Kingdom (UK); in North Africa: Tunisia; and in Asia: Malaysia and the Philippines.

The occurrence of new cases seems to follow a seasonal pattern, with increasing incidence from March‐April onwards. The number of cases sharply increased since mid‐March 2014, essentially in KSA and UAE, where 2 important healthcare‐associated outbreaks are occurring.

As much as 75 percent of the recently reported cases appear to be secondary cases, meaning that they are considered to have acquired the infection from another infected person. The majority of these secondary cases are mainly healthcare workers who have been infected within the healthcare setting, although several patients who were in the hospital for other reasons are also considered to have been infected with MERS‐CoV in the hospital .

The majority of the infected healthcare workers presented with no or minor symptoms. Only 4 instances of transmission within households have been reported, and no large family cluster has been identified. When human‐to‐human transmission occurred, transmission was not sustained, and to date only 2 possible tertiary cases have been reported.

The number of cases who acquired the infection in the community has also increased since mid‐March [2014]. These cases have no reported contacts with other laboratory confirmed cases, and some have reported contacts with animals. Although camels are suspected to be the primary source of infection for humans, the exact routes of direct or indirect exposure remain unknown. Investigations to identify the source of infection and routes of exposure are still ongoing.

Several of the recent cases acquired the infection in KSA or UAE and then travelled to another country, including Greece (1 case), Jordan (1 case), Malaysia (1 case), and the Philippines (1 case). No further transmission has been documented so far. Of note, exported cases occurred in the past that resulted in limited further human‐to‐human transmission (France and UK). In view of the increasing number of cases - in particular secondary cases, nosocomial outbreaks and exported cases - the WHO risk assessment has been revisited to determine whether transmission pattern has changed and whether sustained community transmission is occurring.

Risk assessment
This risk assessment is based on currently available data and knowledge, and will be updated as more information is made available. The investigations are still ongoing and new findings on, for example, exposures to animal and/or environmental source, transmission chains, risk factors for infection among primary cases and healthcare workers, and serological investigations will be critical to make the risk assessment more robust.

Has the transmission pattern of MERS‐CoV changed?
The majority of the cases now reported have likely acquired infection through human‐to‐human transmission and only about a quarter are considered as primary cases, which suggests slightly more human‐to‐human transmission than previously observed.

One hypothesis is that the transmission pattern and transmissibility have not changed and that the occurrence of 2 large nosocomial outbreaks reflects inadequate infection prevention and control measures, coupled with intensive contact tracing and screening. Several elements would support this hypothesis: i) the clinical picture appears to be similar to what was observed earlier; secondary cases tend to present with a milder disease than that of primary cases; however, we note that many secondary cases have been reported as asymptomatic; ii) only 2 possible tertiary cases have been reported; iii) the recent exported cases did not transmit further; iv) screening of contacts revealed very few instances of household transmission; and v) no increase in the size or number of household or community clusters has been observed.

An alternative hypothesis is that transmissibility of the virus has increased and is resulting in more human‐to‐human transmission as the basis for the recent upswing in cases. It is possible that current levels of surveillance are missing cases of mild infection within the community. At this point, there is insufficient information on the recent cases to definitively exclude these hypotheses.

Can we expect additional cases of MERS‐CoV infection in the Middle‐East countries?
The way humans become infected from an animal and/or environmental source is still under investigation. More individuals are likely to be infected until the mode of transmission is determined and preventive measures implemented to break transmission from the source to humans. For the 3rd consecutive year, the number of cases increase in March‐April and it is very likely that more primary cases will occur, and consequently further transmission will occur.

Can we expect additional cases exported to other countries and further transmission?
It is very likely that cases will continue to be exported to other countries, through tourists, travellers, guestworkers or pilgrims, who might acquire the infection following an exposure to the animal or environmental source, or to other cases, in a hospital for instance. Whether these cases will further transmit will depend of the capacity of the receiving country to rapidly detect, diagnose and implement appropriate infection prevention and control measures. Of note, further transmission from exported cases did occur in the past, but transmission was not sustained.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The observation that 75 percent of newly reported cases have occurred via person-to-person transmission is a significant change in previous transmission patterns, but the stated lack of evidence of sustained chains of transmission may be reassuring. Those data supporting this observation have not been readily available for review. It does appear that there are now 3 probably nosocomial outbreaks ongoing - one in Jeddah Saudi Arabia, another in Riyadh Saudi Arabia and a 3rd in Abu Dhabi, UAE. It is curious that these nosocomial outbreaks have now occurred in 3 consecutive years around this time of year. The observation that a large proportion of the secondary transmission associated infections have resulted in asymptomatic and mild clinical expression of disease. There definitely has been an increased awareness of the need for contact tracing and testing, probably contributing to this observed increase in occurrence. One also wonders if current specimen collection and laboratory diagnostic procedures have improved over the course of these 3 years, in the early days of recognition of MERS, studies were done on hospital based and close personal contacts that were predominantly negative in terms of finding MERS-CoV infection, yet verbal histories on these contacts did reveal numbers of contacts reporting mild respiratory illnesses in the time frame consistent with being within the incubation period post exposure.

Given the high amount of travel within the region as well as to and from other regions, there are concerns re: more importations of MERS-CoV infected individuals into areas with limited resources for adequate testing of specimens and for adequate implementation of infection control measures to prevent further transmission locally. - Mod.MPP]

******
[7] Greece ex Saudi Arabia - ECDC update
Date: 23 Apr 2014
Source: ECDC
http://www.ecdc.europa.eu/en/press/news ... 568&ID=989


Epidemiological update: 1st imported case of MERS-CoV in Greece - 23 Apr 2014
------------------------
​On [18 Apr 2014], the Hellenic Centre for Disease Control and Prevention (KEELPNO) announced a laboratory confirmed case of MERS-CoV infection in a 69 year old male patient. The individual is a Greek citizen, permanently residing in Jeddah, Saudi Arabia, who arrived in Athens on [17 Apr 2014] on a flight via Amman, Jordan. Close contact tracing is ongoing; there are no suspected or confirmed cases of MERS-CoV infection associated with this individual to date.

The individual 1st sought medical attention with signs of illness on [8 Apr 2014] in Jeddah and was discharged on [10 Apr 2014] with a diagnosis of probable typhoid fever. His wife was hospitalised in the same hospital in Jeddah from [31 Mar 2014 to 5 Apr 2014] with laboratory confirmed typhoid fever. He sought medical attention the same day of his arrival in Greece [17 Apr 2014] for prolonged fever and diarrhea.

The patient is currently in stable condition receiving antimicrobial therapy and oseltamivir.

As of [22 Apr 2014], 333 laboratory confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 107 deaths. Of these, only 15 have been reported outside of the Middle East including only 10 in Europe.

ECDC is working closely with KEELPNO, the World Health Organization and other international partners with regard to this public health event.

In earlier Rapid Risk Assessments, ECDC concluded that the risk of importation of MERS-CoV to the EU was expected to continue and the risk of secondary transmission in the EU remains low. ECDC is currently revisiting its Rapid Risk Assessment which will be published in the coming days.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[From the above provided background investigation, it appears as though this case is part of the ongoing nosocomial transmission occurring in Jeddah. We await further information on contact tracing.

For a ProMED/HealtMap of Greece, see http://healthmap.org/promed/p/83 - Mod.MPP]

[According to the information page on MERS-CoV on the Saudi MOH website, there have now been 299 laboratory confirmed cases of MERS-CoV infection including 87 deaths in Saudi Arabia. This total number of cases has changed 3 times today (24 Apr 2014) presumably as new information has become available. Yesterday (23 Apr 2014) there were a total of 24 confirmed MERS-CoV infection announced in Saudi Arabia, and today (24 Apr 2014) an additional 12 cases and 2 deaths were reported earlier, but this has increased by 2 more cases and 2 more deaths throughout the course of the time of preparation of this post. This moderator is fairly sure these numbers will continue to increase as more laboratory results are received by the MOH, and more information on the cases becomes available. Hence, she is requesting patience and tolerance on the part of the readers for probable/possible discrepancies that may arise as the tally of total numbers of confirmed is currently a very rapidly moving target.

The WHO risk assessment is in accord with what is being observed. The global tally reported by WHO in today's update(s) included in this post is significantly lower than other tallies as many of the newly reported cases of MERS-CoV infection from Saudi Arabia have not as yet been included in these global tallies. The tally of total MERS-CoV infected cases this moderator has is now approximately 366 including approximately 107 deaths. - Mod.MPP





]


See Also
MERS-CoV - Eastern Mediterranean (39): Qatar (RY) animal res., camel, OIE 20140424.2426491
MERS-CoV - Eastern Mediterranean (38): animal reservoir, camel, Saudi Arabia, RFI 20140423.2424953
MERS-CoV - Eastern Mediterranean (37): Saudi Arabia, UAE 20140422.2420072
MERS-CoV - Eastern Mediterranean (36): Greece ex Saudi Arabia, WHO 20140421.2417384
MERS-CoV - Eastern Mediterranean (35): Greece, Saudi Arabia, UAE, RFI 20140419.2415087
MERS-CoV - Eastern Mediterranean (34): animal reservoir, camel, Saudi Arabia, RFI 20140419.2414479
MERS-CoV - Eastern Mediterranean (33): Saudi Arabia 20140418.2413921
MERS-CoV - Eastern Mediterranean (32): Saudi Arabia, UAE, Malaysia, WHO, RFI 20140417.2411430
MERS-CoV - Eastern Mediterranean (31): Saudi Arabia, Malaysia, UAE, Philippines 20140416.2406647
MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI 20140414.2403986
MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI 20140413.2401723
MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia 20140412.2398280
MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening 20140410.2395733
MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763
MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, UAE, RFI 20140408.2390003
MERS-CoV - Eastern Mediterranean (24): Saudi Arabia, RFI 20140406.2385665
MERS-CoV - Eastern Mediterranean (23): Saudi Arabia 20140404.2378035
MERS-CoV - Eastern Mediterranean (22): UAE, WHO 20140401.2373381
MERS-CoV - Eastern Mediterranean (18): Saudi Arabia 20140321.2347610
MERS-CoV - Eastern Mediterranean (17): Kuwait, UAE, Saudi Arabia, WHO, RFI 20140320.2345849
MERS-CoV - Eastern Mediterranean (16): Saudi Arabia, WHO 20140318.2340740
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, WHO, RFI 20140317.2338519
MERS-CoV - Eastern Mediterranean (14): Saudi Arabia, RFI 20140314.2333773
MERS-CoV - Eastern Mediterranean (13): Saudi Arabia, UAE, WHO 20140313.2330878
MERS-CoV - Eastern Mediterranean (12): Saudi Arabia 20140306.2317828
MERS-CoV - Eastern Mediterranean (11): Saudi Arabia, WHO 20140301.2308415
MERS-CoV - Eastern Mediterranean (08): Saudi Arabia 20140220.2289977
MERS-CoV - Eastern Mediterranean (07): Saudi Arabia 20140215.2280653
MERS-CoV - Eastern Mediterranean (06): UAE (Abu Dhabi) 20140208.2264161
MERS-CoV - Eastern Mediterranean (05): Saudi Arabia, WHO 20140203.2252192
MERS-CoV - Eastern Mediterranean (04): Saudi Arabia, Jordan, WHO 20140128.2235722
MERS-CoV - Eastern Mediterranean (03): Oman, WHO 20140109.2162284
MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
2013
----
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612
MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat 20131219.2126531
MERS-CoV - Eastern Mediterranean (100): Saudi Arabia, WHO 20131219.2126258
MERS-CoV - Eastern Mediterranean (99): animal reservoir, camel, Qatar 20131217.2120936
MERS-CoV - Eastern Mediterranean (98): animal reserv/camel, Jordan, Saudi Arabia 20131213.2114362
MERS-CoV - Eastern Mediterranean (95): animal reservoir, camel, Qatar 20131129.2082942
MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar 20131129.2082330
MERS-CoV - Eastern Mediterranean (93): animal res., camel conf, Qatar (RY) OIE 20131129.2082115
MERS-CoV - Eastern Mediterranean (91): Saudi Arabia, WHO 20131127.2078860
MERS-CoV - Eastern Mediterranean (90): Saudi Arabia, Qatar fatal 20131120.2064667
MERS-CoV - Eastern Mediterranean (88): Kuwait, WHO, Spain 20131119.2062587
MERS-CoV Eastern Mediterranean (87): animal res. camel susp. precautions 20131113.2053932
MERS-CoV - Eastern Mediterranean (86): Kuwait, 1st rep, susp, RFI 20131113.2052320
MERS-CoV - Eastern Mediterranean (85): animal reservoir, camel, susp, official 20131112.2051424
MERS-CoV - Eastern Mediterranean (84): Saudi Arabia, Oman, deaths, WHO, RFI 20131112.2049026
MERS-CoV - Eastern Mediterranean (82): Qatar, RFI 20131110.2047575
MERS-CoV - Eastern Mediterranean (81): Saudi Arabia, UAE ex Oman, RFI 20131108.2044846
MERS-CoV - Eastern Mediterranean (70): Saudi Arabia, WHO 20130913.1936342
MERS-CoV - Eastern Mediterranean (60): Qatar, new case, RFI 20130827.1904425
MERS-CoV - Eastern Mediterranean (51): Saudi Arabia, WHO, RFI 20130801.1857286
MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, WHO 20130709.1813691
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, Italy ex Jordan, WHO, RFI 20130601.1749096
MERS-CoV - Eastern Mediterranean (12): Saudi Arabia, France 20130528.1741836
MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864
Novel coronavirus - Eastern Mediterranean (24): France, 2nd case 20130512.1707305
Novel coronavirus - Eastern Mediterranean (20): France ex UAE, WHO, Saudi Arabia 20130508.1700034
Novel coronavirus - Eastern Mediterranean (14): Germany ex UAE, WHO, fatal 20130326.1604564
Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI 20130323.1600113
Novel coronavirus - Eastern Mediterranean (11): UK, pers to pers transm 20130316.1588808
Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany 20130221.155410
Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp 20130213.1541531
Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan 20130212.1539086
2012
----
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia (14): KSA MOH 20121022.1358297
Novel coronavirus - Saudi Arabia (12): RFI 20121019.1353615
Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012 20120925.1308001
Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar 20120923.1305982
Novel coronavirus - Saudi Arabia (02): additional cases, RFI 20120923.1305931
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733
.................................................mpp/lm

_________________
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