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PostPosted: Thu May 15, 2014 2:22 pm 
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WHO update describes 14 MERS cases including asymptomatic hospital employees with no known contact to confirmed cases.

http://www.who.int/csr/don/2014_05_15_mers/en/

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PostPosted: Thu May 15, 2014 2:23 pm 
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United Arab Emirates

On 11 May 2014, the National IHR Focal Point of the United Arab Emirates reported nine additional MERS-CoV cases residing in Abu Dhabi. Two are UAE nationals, one is an Omani national, and six are of different nationalities but residing in Abu Dhabi.
A 51-year old male Omani national, residing in Al Buraimi, Oman, developed fever on 18 April 2014. He was admitted to the hospital on 20 April 2014. On 23 April 2014 he tested positive for MERS-CoV. He is currently in hospital in isolation in a stable condition. The patient has comorbidities, no history of travel, no contact with animals, and no history of contact with a laboratory confirmed case of MERS-CoV. The IHR NFP for Oman was already informed about this case.
A 39-year-old female health-care worker, residing in Abu Dhabi, who was screened as part of contact investigation. She was asymptomatic; MERS-CoV was confirmed by the laboratory on the 25 April 2014. She has a history of exposure to a confirmed case of MERS-CoV notified to WHO on 18 April 2014. She has no comorbidities, no history of travel, and no contact with animals.
A 30-year old male UAE national, residing in Abu Dhabi. On 24 April 2014, he went to the emergency room with cough and shortness of breath, but he was clinically stable, and was treated as an outpatient. On 25 April, he tested positive for MERS-CoV. He is currently in hospital in a good general condition. The patient had reported comorbidities, no history of recent travel, no history of animal contact, and no history of contact with a laboratory confirmed case of MERS-CoV.
A 42-years old male UAE national, residing in Abu Dhabi, who was asymptomatic and was screened as a contact of the first case in this notification. On 25 April 2014, he tested positive for MERS-CoV. He has no history of travel and no history of contact with animals.
A 30-year old female health-care worker residing in Abu Dhabi. She had a sore throat on 15 April 2014; a sputum sample was taken on 16 April 2014 as part of a general screening of health-care workers following a cluster of cases in the hospital. She tested positive for MERS-CoV on the 17 April 2014 and was admitted to hospital the same day. She was discharged on the 22 April 2014. She has no comorbidity, no significant travel history, and no contact with animals.
A 44-year old male health-care worker residing in Abu Dhabi. He had a mild sore throat that started on the 19 April 2014. He had contact on 13 April at a social gathering with a confirmed case reported to WHO on 17 April 2014. The patient tested positive for MERS-CoV on 21 April 2014 and was admitted to hospital on 22 April 2014. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.
A 41-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 21 April, he tested positive for MERS-CoV and was admitted to hospital on 22 April. He was discharged on 27 April 2014. He has no comorbidities, no significant travel history, and no contact with animals
A 68-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 23 April, he tested positive for MERS-CoV and was admitted to hospital on 24 April 2014 for isolation. He was discharged on 30 April 2014. He has reported comorbidities, has no significant travel history, and no contact with animals.
A 45-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 26 April, he tested positive for MERS-CoV and was admitted to hospital on the same day for isolation. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.

On 8 May 2014, the National IHR Focal Point for the United Arab Emirates (UAE) reported an additional four laboratory-confirmed cases of infection with MERS-CoV.
A 37 year-old male expatriate construction worker in Abu Dhabi who became ill on 23 April 2014 and was hospitalized on 29 April 2014. He tested positive for MERS-CoV on 1 May 2014 and is currently in the intensive care unit (ICU) in a critical but stable condition. He is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals.
A 38 year-old female administrative officer in a health clinic from Abu Dhabi who became ill on 20 April 2014. She was admitted to hospital on 26 April 2014. Initial laboratory tests for MERS-CoV were negative for the virus, but a follow-up test on 27 April 2014 returned positive on 1 May 2014. Currently, the patient is in the ICU in a critical but stable situation. She has several comorbidities, but is also to have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
A 61 year-old male expatriate tailor shop owner residing in Abu Dhabi. He has been hospitalized since 18 March 2014 as a case of atrial fibrillation and chronic obstructive pulmonary disease (COPD). Samples collected on 29 April 2014 and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. Currently, he is in the ICU in a critical but stable condition. He is reported have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
A 34 year-old female expatriate residing in Abu Dhabi. She is asymptomatic. She was detected through mass screening of her work place without being in contact with any known case. Samples collected on 29 April 2014 and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. She is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals. She is a vegetarian and consumes only pasteurized dairy products.

One additional case not previously reported was provided to WHO on 8 April 2014 by the National IHR Focal Point for UAE:
A 59 year-old male farm employee residing in Abu Dhabi. The patient had onset of symptoms on 28 March 2014 with febrile illness. On 30 March 2014, he was admitted to hospital and was being treated in the ICU. On 3 April 2014, he was laboratory confirmed with MERS-CoV. He is reported to have had contact with an admitted laboratory confirmed case of MERS-CoV.

Public health authorities continued to carry out contact tracing and an epidemiological investigation. Further developments will be communicated when available.

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PostPosted: Thu May 15, 2014 8:49 pm 
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A second MERS-CoV (Middle East respiratory syndrome coronavirus) case was reported in the Netherlands today, while Saudi Arabia cited three new cases. In addition, scientists said serologic testing has retrospectively confirmed seven more cases in the first known MERS-CoV outbreak, which occurred in Jordan in April 2012.

Also today, the World Health Organization (WHO) released an update that confirmed and added information on 18 recent cases, including 14 in the United Arab Emirates (UAE) and single cases in the Netherlands, the United States, Jordan, and Lebanon.

Second Dutch case linked to first

The new case in the Netherlands involves a female relative of the country's first case-patient, a man who fell ill after a recent trip to Saudi Arabia, according to the National Institute for Public Health and the Environment. A computer translation of the statement was posted on Avian Flu Diary, an infectious disease blog.

The agency said the woman, like the man, became infected in Saudi Arabia, and she is now in "strict isolation" and stable condition. She and the man shared a hotel room for 2 weeks, and both have underlying conditions, the statement said.

Today's WHO statement said the first Dutch patient is a 70-year-old Dutch citizen who traveled to Saudi Arabia between Apr 26 and May 10. He first felt ill while in Medina on May 1, and on May 6 he was examined in Mecca.

He had no respiratory symptoms until his return home on May 10, and he was hospitalized the same day, the WHO said. He is now in stable condition in an intensive care unit (ICU).

Three more cases in Riyadh

The three new cases reported in Saudi Arabia today include one death. All three are in Riyadh, which is a hotbed of recent MERS activity, ranking second behind Jeddah in the number of cases.

The fatal case involved a 54-year-old woman who had chronic conditions and was hospitalized May 3 with an arteriovenous fistula, the Saudi Ministry of Health (MOH) said in its update. She experienced respiratory symptoms on May 5 and was subsequently moved to an ICU; she died on May 13.

A second case-patient is a 70-year-old woman who has chronic conditions but has no symptoms and is in home isolation, the MOH said. The other patient is a 39-year-old woman who has diabetes and was hospitalized with respiratory symptoms on Apr 24. After twice testing negative for MERS-CoV, she tested positive on May 13, and she is in stable condition.

The MOH didn't give any information about how the three women were exposed to the virus, nor did it say whether any of them are healthcare workers (HCWs).

The new cases raise Saudi Arabia's MERS tally to 514 cases with 160 deaths.

The ministry also reported two deaths in previously reported cases, involving a 72-year-old woman and a 63-year-old man, both in Jeddah.

Jordan cases retrospectively confirmed

The earliest known MERS-CoV outbreak occurred in a Zarqa, Jordan, hospital in April 2012, but it was not recognized as such until November 2012, after the virus had been identified and described as a result of cases in Saudi Arabia.

The outbreak involved 13 pneumonia cases, including 2 deaths. Investigators previously confirmed MERS-CoV in the two fatal cases by testing stored specimens, leaving the other 11 cases in the suspected category. Now Jordanian and US investigators have confirmed seven more cases through serologic (antibody) tests, according to their report published yesterday in Clinical Infectious Diseases.

The authors interviewed and collected serum samples from 124 people, including the outbreak patients, their household contacts, HCWs, and field investigators from the Jordanian health ministry. Among those tested were 9 of the 11 surviving outbreak patients.

Seven people tested positive for MERS-CoV antibodies on at least two of three serologic tests, increasing the outbreak count to nine. Of the 7 newly confirmed cases, 6 were surviving outbreak patients, and 5 were HCWs, according to the report.

With 6 HCWs among the 9 cases in the outbreak, the attack rate among potentially exposed HCWs was 10%, the authors found. There was no evidence of MERS CoV transmission at two hospitals to which outbreak patents were transferred and which, the authors said, had better infection control practices than the outbreak facility.

Of the 9 cases in the outbreak, 6 people were male, and the median age was 40 years. Most of the patients had no major preexisting conditions, although two had hypertension. Their relative youthfulness and their generally good underlying health probably explains why the outbreak case-fatality rate of 22% was lower than has been observed in MERS cases generally, the authors say.

The authors determined that each of the serologically confirmed case-patients had been exposed to at least one patient whose infection was confirmed by polymerase chain reaction.

The study shed no light on the source of the virus: The authors found no evidence that any patients had contact with camels, and none of them had traveled to or received visitors from the Arabian Peninsula before they got sick.

WHO update

Most of today's WHO update deals with 14 MERS cases reported by the UAE, but it also reviews recent US, Dutch, Lebanese, and Jordanian cases.

The UAE cases were reported to the WHO on Apr 8, May 8, and May 11. Seven of the 14 patients are described as HCWs and several of them as expatriates. The age range is from 30 to 68 years. Three patients were listed as asymptomatic.

Most of them had no contact with other confirmed cases, and none reported contact with animals, according to the statement. Several of the cases were identified as a result of general screening at their workplaces.

The WHO provided some new details on Lebanon's first MERS case, which was reported a week ago in media reports that contained very little information. The WHO said the patient is a 60-year-old male HCW and Lebanese national who got sick on Apr 22.

He was hospitalized on Apr 30 and tested positive for MERS-CoV 2 days later, the agency said. On May 7 was he was released from the hospital.

Eight weeks before his illness, the man had traveled to Jeddah, where he visited one of the hospitals that recently has had a surge of MERS cases, the WHO said. In addition, he visited the UAE 5 weeks before his illness, but he did not travel in the 2 weeks before he got sick.

The WHO increased its global MERS count to 572 cases, including 173 deaths. The number includes 58 cases that Saudi Arabia reported to the agency from May 5 to 9. The WHO said it is gathering more information about those cases in preparation for providing further updates.

Florida HCWs test negative

In developments related to the second imported US MERS case, the Florida Department of Health (FDH) in Orange County said today that the patient, hospitalized in Orlando, continues to improve and that tests are negative for all HCWs who had contact with him.

Yesterday health officials announced that tests cleared two health workers who had flu-like symptoms after unprotected contact with the patient, a HCW who lives and works in Jeddah, Saudi Arabia, and started feeling ill on a flight to visit the United States. The 44-year-old man sought care on May 8 at a Florida hospital, and tests on May 11 revealed that he was infected with MERS-CoV.

Staff writer Lisa Schnirring contributed to this story.

See also:

May 15 Avian Flu Diary post with Dutch statement on second case

May 15 Saudi MOH report on three new cases

May 14 Clin Infect Dis abstract on Jordanian outbreak

Jun 19, 2013, CIDRAP News story on Jordan outbreak

May 15 WHO statement

May 15 FDH statement

http://www.cidrap.umn.edu/news-perspect ... mers-tally

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PostPosted: Thu May 15, 2014 11:19 pm 
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Published Date: 2014-05-15 22:32:30
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (60): Middle East, Netherlands, USA, WHO
Archive Number: 20140515.2474996

MERS-COV - EASTERN MEDITERRANEAN (60): SAUDI ARABIA, NETHERLANDS, UAE, LEBANON, USA, JORDAN, WHO
************************************************************************************************
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, 3 new cases, 3 deaths
[2] Netherlands (1), USA (1), UAE (14), Lebanon (1), Jordan (1) - WHO update - 15 May 2014
[3] Netherlands, 2nd case - media report
[4] Jordan, 7 cases serologically confirmed April 2012

******
[1] Saudi Arabia, 3 new cases, 3 deaths
Date: Thu 15 May 2014
Source: Saudi MOH [edited]
http://www.moh.gov.sa/en/CoronaNew/Pres ... 5-001.aspx


MOH: 3 New Confirmed Corona Cases Recorded
------------------------------------------
Daily Report of (MERS-CoV) Cases
As of 12 pm Local Time in Makkah on Wednesday [Thursday], 15 May 2014

Total numbers of confirmed cases in last 24 hours: 3 cases
Recovered and discharged cases that previously tested positive and are now negative: 8 cases
The total number of deaths: 3 cases (1 case was recorded over the past 24 hours and the other 2 are from previously confirmed cases)

Overview of the health status of the cases:
- 1 stable case
- 1 case without symptoms
- 1 death

Health situation of the cases in detail:
In Riyadh:
- A 54-year-old female suffering from diabetes mellitus, hypertension and chronic renal failure. She was admitted to a government hospital on [3 May 2014] due to clotting in arteriovenous fistula. On [5 May 2014], she developed respiratory symptoms. Her condition deteriorated and was admitted to the ICU. She passed away on [13 May 2014].
- A 70-year-old female suffering from diabetes mellitus and hypertension. She does not have any symptoms and is currently in home isolation.
- A 39-year-old female suffering from diabetes mellitus. She developed respiratory symptoms on [23 Apr 2014] and was admitted to a government hospital on [24 Apr 2014]. She tested negative twice for MERS. She had a 3rd test on [13 May 2014] and tested positive. Her condition is stable.

Deaths in previously reported cases:
- A 72-year-old female. She was admitted to a government hospital in Jeddah and her case was reported on [10 May 2014]. She passed away on [14 May 2014].
- A 63-year-old male. He was admitted to a government hospital in Jeddah and his case was reported on [4 May 2014]. He passed away on [14 May 2014].

Recovery in previously reported cases:
- A 42-year-old female was discharged from a government hospital in Jeddah on [14 May 2014].
- A 57-year-old male was discharged from a private hospital in Jeddah on [14 May 2014].
- A 47-year-old male was discharged from a government hospital in Jeddah on [14 May 2014].
- A 26-year-old female was discharged from a private hospital in Jeddah on [14 May 2014].
- A 30-year-old female was discharged from a government hospital in Riyadh on [14 May 2014].
- A 36-year-old female was discharged from a government hospital in Riyadh on [14 May 2014].
- A 38-year-old female was discharged from a government hospital in Riyadh on 14 May 2014].
- A 37-year-old female was discharged from a government hospital in Riyadh on [13 May 2014].

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

[With the addition of these 3 newly confirmed MERS-CoV infections and 3 newly reported deaths, the total number of MERS-CoV infected individuals in Saudi Arabia is now 514 including 160 deaths. All 3 of the newly confirmed infections were in individuals with co-morbidities and at least one of them had been admitted to the hospital for illness related to the co-morbidities significantly earlier than the onset of respiratory symptoms consistent with MERS-CoV infection. Another case was admitted for respiratory symptoms but was negative for MERS-CoV infection twice until found positive approximately 3+ weeks after admission. All 3 of the newly confirmed cases were reported in Riyadh, while the 2 fatalities in previously reported MERS-CoV infected individuals were in Jeddah. A map showing the locations of the newly confirmed cases and deaths can be found at the source URL. - Mod.MPP]

******
[2] Netherlands (1), USA (1), UAE (14), Lebanon (1), Jordan (1) - WHO update - 15 May 2014
Date: Thu 15 May 2014
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2014_05_15_mers/en/


Middle East respiratory syndrome coronavirus (MERS-CoV) -- update
-----------------------------------------------------------------
The following cases of laboratory confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported from Jordan, Lebanon, the Netherlands, the United Arab Emirates, and the United States.

Netherlands
-----------
On 14 May 2014, the National IHR Focal Point for the Netherlands notified WHO of the 1st laboratory confirmed case of MERS-CoV infection in the Netherlands. The patient is a 70 year-old male citizen of the Netherlands, with travel history to the Kingdom of Saudi Arabia between [26 Apr 2014] and 10 May 2014.

The patient developed 1st symptoms on 1 May 2014 while in Medina, Saudi Arabia. He was evaluated at an emergency care department in Mecca on [6 May 2014] and given antibiotics; he did not have respiratory symptoms while in Saudi Arabia. On return to the Netherlands, on [10 May 2014], his condition deteriorated, including development of respiratory symptoms, and he was hospitalized on the same day. On [13 May 2014], he tested positive for MERS-CoV. Currently, the patient is in the ICU in a stable condition.

The patient reports no contact with animals or consumption of raw animal products. Identification of close contacts, including flight contacts has been initiated.

United States of America
------------------------
On 12 May 2014, the United States IHR National Focal Point reported the 2nd laboratory confirmed MERS-CoV infection in the United States in a male health-care worker in his 40s, who lives and works in Jeddah, Saudi Arabia.

He travelled to the United States from Jeddah on 1 May 2014 on commercial flights via London Heathrow with travel from London to Boston, Massachusetts; from Boston to Atlanta, Georgia; and from Atlanta to Orlando, Florida.

He began feeling unwell on 1 May 2014 on the flight from Jeddah to London with a low-grade fever, chills, and a slight cough. On 9 May 2014, he was seen in an emergency room and hospitalized. The patient is in a stable condition.

The Division of Global Migration and Quarantine (DGMQ) from the US Centers for Disease Control and Prevention (CDC) continues to work with local, state, and international partners, as well as with the airlines to obtain the passenger manifests from the flights to help identify, locate, and interview contacts.

United Arab Emirates
--------------------
On 11 May 2014, the National IHR Focal Point of the United Arab Emirates reported 9 additional MERS-CoV cases residing in Abu Dhabi. Two are UAE nationals, one is an Omani national, and 6 are of different nationalities but residing in Abu Dhabi.

- A 51-year-old male Omani national, residing in Al Buraimi, Oman, developed fever on [18 Apr 2014]. He was admitted to the hospital on [20 Apr 2014]. On [23 Apr 2014] he tested positive for MERS-CoV. He is currently in hospital in isolation in a stable condition. The patient has comorbidities, no history of travel, no contact with animals, and no history of contact with a laboratory confirmed case of MERS-CoV. The IHR NFP for Oman was already informed about this case.
- A 39-year-old female health-care worker, residing in Abu Dhabi, who was screened as part of contact investigation. She was asymptomatic; MERS-CoV was confirmed by the laboratory on the [25 Apr 2014]. She has a history of exposure to a confirmed case of MERS-CoV notified to WHO on [18 Apr 2014]. She has no comorbidities, no history of travel, and no contact with animals.
- A 30-year-old male UAE national, residing in Abu Dhabi. On [24 Apr 2014], he went to the emergency room with cough and shortness of breath, but he was clinically stable, and was treated as an outpatient. On [25 Apr 2014], he tested positive for MERS-CoV. He is currently in hospital in a good general condition. The patient had reported comorbidities, no history of recent travel, no history of animal contact, and no history of contact with a laboratory confirmed case of MERS-CoV.
- A 42-year-old male UAE national, residing in Abu Dhabi, who was asymptomatic and was screened as a contact of the 1st case in this notification. On [25 Apr 2014], he tested positive for MERS-CoV. He has no history of travel and no history of contact with animals.
- A 30-year-old female health-care worker residing in Abu Dhabi. She had a sore throat on [15 Apr 2014]; a sputum sample was taken on [16 Apr 2014] as part of a general screening of health-care workers following a cluster of cases in the hospital. She tested positive for MERS-CoV on [17 Apr 2014] and was admitted to hospital the same day. She was discharged on the [22 Apr 2014]. She has no comorbidity, no significant travel history, and no contact with animals.
- A 44-year-old male health-care worker residing in Abu Dhabi. He had a mild sore throat that started on the [19 Apr 2014]. He had contact on [13 Apr 2014] at a social gathering with a confirmed case reported to WHO on [17 Apr 2014]. The patient tested positive for MERS-CoV on [21 Apr 2014] and was admitted to hospital on [22 Apr 2014]. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.
- A 41-year-old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On [21 Apr 2014], he tested positive for MERS-CoV and was admitted to hospital on [22 Apr 2014]. He was discharged on [27 Apr 2014]. He has no comorbidities, no significant travel history, and no contact with animals.
- A 68-year-old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On [23 Apr 2014], he tested positive for MERS-CoV and was admitted to hospital on [24 Apr 2014] for isolation. He was discharged on [30 Apr 2014]. He has reported comorbidities, has no significant travel history, and no contact with animals.
- A 45-year-old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On [26 Apr 2014], he tested positive for MERS-CoV and was admitted to hospital on the same day for isolation. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.

On 8 May 2014, the National IHR Focal Point for the United Arab Emirates (UAE) reported an additional 4 laboratory-confirmed cases of infection with MERS-CoV.

- A 37-year-old male expatriate construction worker in Abu Dhabi who became ill on [23 Apr 2014] and was hospitalized on [29 Apr 2014]. He tested positive for MERS-CoV on 1 May 2014 and is currently in the intensive care unit (ICU) in a critical but stable condition. He is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals.
- A 38-year-old female administrative officer in a health clinic from Abu Dhabi who became ill on [20 Apr 2014]. She was admitted to hospital on [26 Apr 2014]. Initial laboratory tests for MERS-CoV were negative for the virus, but a follow-up test on [27 Apr 2014] returned positive on 1 May 2014. Currently, the patient is in the ICU in a critical but stable situation. She has several comorbidities, but is also to have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
- A 61-year-old male expatriate tailor shop owner residing in Abu Dhabi. He has been hospitalized since [18 Mar 2014] as a case of atrial fibrillation and chronic obstructive pulmonary disease (COPD). Samples collected on [29 Apr 2014] and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. Currently, he is in the ICU in a critical but stable condition. He is reported have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
- A 34-year-old female expatriate residing in Abu Dhabi. She is asymptomatic. She was detected through mass screening of her work place without being in contact with any known case. Samples collected on [29 Apr 2014] and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. She is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals. She is a vegetarian and consumes only pasteurized dairy products.

One additional case not previously reported was provided to WHO on 8 Apr 2014 by the National IHR Focal Point for UAE:
- A 59-year-old male farm employee residing in Abu Dhabi. The patient had onset of symptoms on [28 Mar 2014] with febrile illness. On [30 Mar 2014], he was admitted to hospital and was being treated in the ICU. On [3 Apr 2014], he was laboratory confirmed with MERS-CoV. He is reported to have had contact with an admitted laboratory confirmed case of MERS-CoV.

Public health authorities continued to carry out contact tracing and an epidemiological investigation. Further developments will be communicated when available.

Jordan
------
On 11 May 2014, the National IHR Focal Point for Jordan reported to WHO an additional case of MERS-CoV.

The case is a 50-year-old male health-care worker, Jordanian citizen, and resident of Zarka Governorate. He presented with symptoms on 7 May 2014. On [10 May 2014] his condition worsened and he was diagnosed with pneumonia after performing a chest X-ray. He was admitted to hospital the same day and tested positive for MERS-CoV. The patient has a history of contact with 2 MERS-confirmed cases. He is in a stable condition. He is reported to have no history of travel and no history of contact with animals.

Tracing and screening of 6 family members and 24 health-care workers for MERS-CoV is currently ongoing.

Lebanon
-------
On 8 May 2014, the National IHR Focal Point (NFP) of Lebanon reported the 1st laboratory-confirmed case of MERS-CoV infection.

On [22 Apr 2014], a 60-year-old male health-care worker and national of Lebanon complained of high-grade fever. On [27 Apr 2014], he was diagnosed with pneumonia and was admitted to the hospital on [30 Apr 2014]. His symptoms included fever, dyspnoea, and productive cough. On 2 May 2014, he tested positive for MERS-CoV. He is reported to have comorbidities. He was in a stable condition in hospital and was released on 7 May 2014.

The patient is reported to have no contact with laboratory confirmed cases or with animals and no history of raw camel milk consumption. No history of travel was reported in the 14 days prior to onset of symptoms.

The patient is known to travel throughout the Gulf region, particularly to Kuwait, Saudi Arabia, and UAE; investigations into the patient's travel history are ongoing. His most recent travel was 5 weeks prior to symptom onset to UAE and 8 weeks prior to symptom onset to Jeddah where he visited one of the hospitals that had been facing an upsurge of MERS-CoV cases.

Globally, 572 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 173 deaths. The global total includes all of the cases reported in this update (18), plus 58 laboratory confirmed cases officially reported to WHO from Saudi Arabia between [5 and 9 May 2014]. WHO is working with Saudi Arabia for additional information on these cases and will provide further updates as soon as possible.

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

******
[3] Netherlands, 2nd case - media report
Date: Thu 15 May 2014
Source: CNN [edited]
http://www.cnn.com/2014/05/15/health/me ... therlands/


A 2nd case of the potentially deadly MERS virus has been identified in the Netherlands, a spokeswoman for the country's National Public Health Institute told CNN. It comes one day after authorities confirmed the 1st case.

The cases in the Netherlands involve 2 family members who had traveled together to Saudi Arabia.

It is one man and one woman who contracted the disease, said Harald Wychgel, spokesman for the Netherlands ministry of health.

The health ministry, citing privacy reasons, did not provide additional details except to say that the pair shared a room for 2 weeks in Saudi Arabia.

Officials do not know if one person infected the other or if both became infected at the same location. One of the 2, however, had visited a camel farm. It is estimated that nearly 75 percent of dromedary -- or single-hump camels -- in Saudi Arabia have come into contact with the MERS virus, researchers said in February [2014].

"It is also known that both patients have underlying conditions that make them probably more susceptible to infection with this virus," the health ministry said in a statement.

The announcement comes as the World Health Organization said the spread of the virus has become more urgent, but at least for now, is not calling it a global health emergency.

The 1st cases of Middle East respiratory syndrome were diagnosed in the Arabian Peninsula in 2012. MERS attacks the respiratory system, and symptoms can lead to pneumonia or kidney failure.

There have been over 570 confirmed cases of MERS, including 171 deaths, according to the World Health Organization.

Many of the cases are in Saudi Arabia and the United Arab Emirates.

Even without any official worldwide alert, Anne Schuchat, the head of the CDC's National Center for Immunization and Respiratory Diseases, acknowledges that "this is a relatively new virus that does have a high fatality rate," ample reason to pay attention. Authorities haven't pinned down all the details about how exactly it arose and how it spreads, though Schuchat said, "We don't have evidence right now that this is airborne ... the way the measles virus is."

Two cases have been confirmed in the United States. Both patients are health care providers who were working in Saudi Arabia. Those cases are in Indiana and Florida.

[Byline: Carol Jordan and Josh Levs]

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

******
[4] Jordan, 7 cases serologically confirmed April 2012
Date: 15 May 2014
Source: CIDRAP
http://www.cidrap.umn.edu/news-perspect ... mers-tally


Dutch, Saudi, Jordan reports boost MERS tally
---------------------------
A 2nd MERS-CoV (Middle East respiratory syndrome coronavirus) case was reported in the Netherlands today, while Saudi Arabia cited 3 new cases. In addition, scientists said serologic testing has retrospectively confirmed 7 more cases in the 1st known MERS-CoV outbreak, which occurred in Jordan in April 2012.

Also today, the World Health Organization (WHO) released an update that confirmed and added information on 18 recent cases, including 14 in the United Arab Emirates (UAE) and single cases in the Netherlands, the United States, Jordan, and Lebanon.

2nd Dutch case linked to 1st
The new case in the Netherlands involves a female relative of the country's 1st case-patient, a man who fell ill after a recent trip to Saudi Arabia, according to the National Institute for Public Health and the Environment. A computer translation of the statement was posted on Avian Flu Diary, an infectious disease blog.

The agency said the woman, like the man, became infected in Saudi Arabia, and she is now in "strict isolation" and stable condition. She and the man shared a hotel room for 2 weeks, and both have underlying conditions, the statement said.

Today's WHO statement said the 1st Dutch patient is a 70-year-old Dutch citizen who traveled to Saudi Arabia between [26 Apr 2014] and [10 May 2014]. He first felt ill while in Medina on [1 May 2014], and on [6 May 2014] he was examined in Mecca.

He had no respiratory symptoms until his return home on [10 May 2014], and he was hospitalized the same day, the WHO said. He is now in stable condition in an intensive care unit (ICU).

3 more cases in Riyadh
The 3 new cases reported in Saudi Arabia today include 1 death. All 3 are in Riyadh, which is a hotbed of recent MERS activity, ranking 2nd behind Jeddah in the number of cases.

The fatal case involved a 54-year-old woman who had chronic conditions and was hospitalized [3 May 2014] with an arteriovenous fistula, the Saudi Ministry of Health (MOH) said in its update. She experienced respiratory symptoms on [5 May 2014] and was subsequently moved to an ICU; she died on [13 May 2014].

A 2nd case-patient is a 70-year-old woman who has chronic conditions but has no symptoms and is in home isolation, the MOH said. The other patient is a 39-year-old woman who has diabetes and was hospitalized with respiratory symptoms on [24 Apr 2014]. After twice testing negative for MERS-CoV, she tested positive on [13 May 2014], and she is in stable condition.

The MOH didn't give any information about how the 3 women were exposed to the virus, nor did it say whether any of them are healthcare workers (HCWs).

The new cases raise Saudi Arabia's MERS tally to 514 cases with 160 deaths.

The ministry also reported 2 deaths in previously reported cases, involving a 72-year-old woman and a 63-year-old man, both in Jeddah.

Jordan cases retrospectively confirmed
The earliest known MERS-CoV outbreak occurred in a Zarqa, Jordan, hospital in April 2012, but it was not recognized as such until November 2012, after the virus had been identified and described as a result of cases in Saudi Arabia.

The outbreak involved 13 pneumonia cases, including 2 deaths. Investigators previously confirmed MERS-CoV in the 2 fatal cases by testing stored specimens, leaving the other 11 cases in the suspected category. Now Jordanian and US investigators have confirmed 7 more cases through serologic (antibody) tests, according to their report published yesterday in Clinical Infectious Diseases.

The authors interviewed and collected serum samples from 124 people, including the outbreak patients, their household contacts, HCWs, and field investigators from the Jordanian health ministry. Among those tested were 9 of the 11 surviving outbreak patients.

Seven people tested positive for MERS-CoV antibodies on at least 2 of 3 serologic tests, increasing the outbreak count to 9. Of the 7 newly confirmed cases, 6 were surviving outbreak patients, and 5 were HCWs, according to the report.

With 6 HCWs among the 9 cases in the outbreak, the attack rate among potentially exposed HCWs was 10 percent, the authors found. There was no evidence of MERS CoV transmission at 2 hospitals to which outbreak patents were transferred and which, the authors said, had better infection control practices than the outbreak facility.

Of the 9 cases in the outbreak, 6 people were male, and the median age was 40 years. Most of the patients had no major preexisting conditions, although 2 had hypertension. Their relative youthfulness and their generally good underlying health probably explains why the outbreak case-fatality rate of 22 percent was lower than has been observed in MERS cases generally, the authors say.

The authors determined that each of the serologically confirmed case-patients had been exposed to at least 1 patient whose infection was confirmed by polymerase chain reaction.

The study shed no light on the source of the virus: The authors found no evidence that any patients had contact with camels, and none of them had traveled to or received visitors from the Arabian Peninsula before they got sick.

WHO update
Most of today's WHO update deals with 14 MERS cases reported by the UAE, but it also reviews recent US, Dutch, Lebanese, and Jordanian cases.

The UAE cases were reported to the WHO on [8 Apr 2014, 8. and 11 May 2014]. Seven of the 14 patients are described as HCWs and several of them as expatriates. The age range is from 30 to 68 years. Three patients were listed as asymptomatic.

Most of them had no contact with other confirmed cases, and none reported contact with animals, according to the statement. Several of the cases were identified as a result of general screening at their workplaces.

The WHO provided some new details on Lebanon's 1st MERS case, which was reported a week ago in media reports that contained very little information. The WHO said the patient is a 60-year-old male HCW and Lebanese national who got sick on [22 Apr 2014].

He was hospitalized on [30 Apr 2014] and tested positive for MERS-CoV 2 days later, the agency said. On [7 May 2014] was he was released from the hospital.

Eight weeks before his illness, the man had traveled to Jeddah, where he visited one of the hospitals that recently has had a surge of MERS cases, the WHO said. In addition, he visited the UAE 5 weeks before his illness, but he did not travel in the 2 weeks before he got sick.

The WHO increased its global MERS count to 572 cases, including 173 deaths. The number includes 58 cases that Saudi Arabia reported to the agency from [5 to 9 May 2104]. The WHO said it is gathering more information about those cases in preparation for providing further updates.

Florida HCWs test negative
In developments related to the 2nd imported US MERS case, the Florida Department of Health (FDH) in Orange County said today that the patient, hospitalized in Orlando, continues to improve and that tests are negative for all HCWs who had contact with him.

Yesterday health officials announced that tests cleared 2 health workers who had flu-like symptoms after unprotected contact with the patient, a HCW who lives and works in Jeddah, Saudi Arabia, and started feeling ill on a flight to visit the United States. The 44-year-old man sought care on [8 May 2014] at a Florida hospital, and tests on [11 May 2014] revealed that he was infected with MERS-CoV.

[Byline: Robert Roos, with Lisa Schnirring]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[According to the WHO report above, the global tally of laboratory confirmed cases of MERS-CoV infection now at 572 including 173 deaths. This is up to date including Saudi reported cases through 9 May 2014. Since 9 May 2014, there have been 41 additional laboratory confirmed MERS-CoV infections including 27 deaths reported on the Saudi MOH website, and a 2nd case was reported by the Netherlands (see above section [3] for details). As the WHO reports have not mentioned the retrospectively serologically confirmed cases in Jordan, this moderator presumes that they should also be added to the global tally, so that the addition of these cases and deaths would bring the global tally to 621 cases including 200 deaths.

Noteworthy is that while 1 of the 2 cases in the Netherlands had a history of visiting a camel farm (the 2nd reported case), the other case had a history of visiting an emergency room in Mecca (the 1st reported case) -- both activities considered to be potential exposure risks. There isn't mention whether the 2nd reported case had accompanied the 1st reported case to the Emergency Room as well. (the original alert posted on the RIVM [National Institute for Public Health and the Environment Netherlands website in Dutch can be found at:http://www.rivm.nl/Documenten_en_publicaties/Algemeen_Actueel/Nieuwsberichten/2014/Tweede_MERS_patient_in_Nederland).

Other noteworthy information in the above reports is the retrospective confirmation of 7 additional cases involved in the 1st documented outbreak of MERS-CoV infections in Jordan in 2012 through improved serologic testing procedures. The abstract of the article can be found at http://cid.oxfordjournals.org/content/e ... 6f0509b134 and contains the same information provided in the CIDRAP report in section [4] above. (Al-Abdallat MM, et.al. Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description. Clin Infect Dis. (2014) doi: 10.1093/cid/ciu359 First published online: May 14, 2014).

The information on the potential risk exposures of the Lebanese case is curious as the potential known risk exposures occurred weeks prior to the onset of illness of this patient (travel to Saudi Arabia and the UAE). It is also curious that the individual is a health care worker. One wonders if this individual had been exposed to undiagnosed MERS-CoV infected individuals in the health care environment in Lebanon, perhaps individuals returning to Lebanon from travel in the Arabian Peninsula.

For a map showing the Arabian Peninsula, see http://healthmap.org/promed/p/131. For a good map showing where cases have been reported/confirmed globally, see Figure 2 in the MMWR report: First Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities - May 2014. 14 May 2014 early release, 16 May 2014, 63(19);431-436, available at http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6319a4_w. - Mod.MPP]


See Also
MERS-CoV - Eastern Mediterranean (59): Saudi Arabia, Netherlands, USA, WHO, RFI 20140514.2471839
MERS-CoV - Eastern Mediterranean (58): Saudi Arabia, USA 20140513.2469369
MERS-CoV - Eastern Mediterranean (57): Saudi Arabia, Jordan, USA 20140512.2466912
MERS-CoV - Eastern Mediterranean (56): Saudi Arabia, RFI 20140511.2465028
MERS-CoV - Eastern Mediterranean (55): Saudi Arabia, Jordan 20140510.2463601
MERS-CoV - Eastern Mediterranean (54): Saudi Arabia, Lebanon 20140509.2461876
MERS-CoV - Eastern Mediterranean (53): Saudi Arabia, Lebanon, RFI 20140509.2459095
MERS-CoV - Eastern Mediterranean (52): Saudi Arabia, Yemen, Jordan, WHO 20140507.2453121
MERS-CoV - Eastern Mediterranean (51): Saudi Arabia, 20140506.2450777
MERS-CoV - Eastern Mediterranean (50): Saudi Arabia, UAE, USA, RFI 20140504.2449373
MERS-CoV - Eastern Mediterranean (49): Saudi Arabia 20140503.2447188
MERS-CoV - Eastern Mediterranean (48): USA ex Saudi Arabia 20140502.2445843
MERS-CoV - Eastern Mediterranean (47): Saudi Arabia, Jordan, Egypt, WHO 20140502.2442560
MERS-CoV - Eastern Mediterranean (45): Saudi Arabia 20140430.2437089
MERS-CoV - Eastern Mediterranean (44): Saudi Arabia 20140428.2433859
MERS-CoV - Eastern Mediterranean (43): Saudi Arabia, Egypt, UAE, WHO 20140427.2431453
MERS-CoV - Eastern Mediterranean (42): Saudi Arabia, genome sequencing, Jeddah 20140426.2432140
MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, UAE, Jordan ex KSA, WHO, RFI 20140424.2424017
MERS-CoV - Eastern Mediterranean (39): Qatar (RY) animal res., camel, OIE 20140424.2426491
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 (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 (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
2013
----
MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612
MERS-CoV - Eastern Mediterranean (100): Saudi Arabia, WHO 20131219.2126258
MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar 20131129.2082330
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 (86): Kuwait, 1st rep, susp, RFI 20131113.2052320
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/je/mpp/dk

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