Coronavirus cases, deaths reported in Tunisia, Saudi Arabia

Robert Roos  News Editor

May 20, 2013 (CIDRAP News) – A media report today said the Middle East respiratory syndrome coronavirus (MERS-CoV) has reached Tunisia, killing one man and infecting two of his relatives, while Saudi Arabia has reported another death and a new case since May 17.

The Kuwait News Agency (KUNA) said today that a 66-year-old man with diabetes died of a MERS-CoV infection after returning from a trip to Saudi Arabia and Qatar and that two relatives tested positive for the virus. The relatives were improving with treatment, the story said.

The man who died was hospitalized with an "acute respiratory condition" in the coastal city of Monastir after he returned home, according to KUNA. The story gave no other details, and the cases have not yet been recognized by the World Health Organization (WHO).

If the KUNA report is accurate, Tunisia is the eighth country to be affected by MERS-CoV, along with Jordan, Saudi Arabia, Qatar, the United Kingdom, France, Germany, and the United Arab Emirates. All of the European cases have had direct or indirect links to the Middle East.

Meanwhile, the WHO reported on May 18 a new MERS-CoV case in Saudi Arabia, involving an 81-year-old woman who is part of a hospital-centered case cluster in the Al-Ahsa region of Eastern province. Her illness increases the cluster to 22 cases, of which 9 have been fatal. Press reports have listed the Al-Moosa General Hospital in Hofuf as the site of the cluster.

The 81-year-old was a patient in the facility from Apr 8 to 28 and was identified in the investigation of the outbreak there, the WHO said. She has "multiple coexisting medical conditions" and is in critical but stable condition. The statement gave no details on how she became infected or on her connections to other patients in the cluster.

In more developments today, Saudi Arabia's Ministry of Health (MOH) reported that a man with "chronic heart diseases, diabetes and high blood pressure, in addition to kidney failure," has died of MERS-CoV. The statement did not say whether his case had been reported previously or list other details such as his age or whether he was part of the hospital case cluster.

An Arab News story today, however, said the man had been a patient at the hospital in Al-Ahsa. His death raised the MERS-CoV death toll in Saudi Arabia to 16, the MOH said.

The Saudi MOH statement also said one healthcare worker who had been sick with the virus has recovered and been released from a hospital. Last week the WHO reported that two healthcare workers, a 45-year-old man and a 43-year-old woman, were part of the healthcare-related case cluster after catching the virus from patients. The MOH statement gave no other information on the worker who recovered.

The WHO's May 18 statement put the global MERS-CoV count at that point at 41 cases with 20 deaths. The Tunisian cases and death and the Saudi Arabia death reported today apparently increase the count to 44 cases and 22 deaths (assuming the deceased Saudi Arabian's illness was reported previously).

The novel virus has spread from person to person in healthcare facilities and in families but has not achieved sustained community transmission. Investigators have not been able to identify the virus's animal origin or exactly how it spreads.

Also today, Saudi Arabian health officials asked the Arab Health Ministers Council to discuss MERS-CoV during its upcoming meeting, according to the Saudi Gazette. The council will meet during the World Health Assembly, the annual meeting of WHO member countries, which began today.

And in other related news, officials at Canada's National Microbiology Laboratory in Winnipeg said they can't provide samples of MERS-CoV to other labs, according to a CBC News story. The report said a material transfer agreement the national lab signed when it obtained the virus from a lab in the Netherlands forbids sending samples to other facilities.

Man dies of flu-like illness

Published on Tuesday, May 21, 2013 00:00

This week, I will be blogging from the 66th World Health Assembly in Geneva, which I'm attending under a UN Foundation press fellowship. One of the first main events was a speech by WHO director-general Dr. Margaret Chan, who chose to open her statement by invoking the memory of SARS.

Why bring up SARS now? Because these days, public health officials are wringing their hands over two new viruses with pandemic potential: the H7N9 bird flu in China and a SARS-related coronavirus that has emerged in the Middle East, now being called MERS (Middle East Respiratory Syndrome).

Both viruses "remind us that the threat from emerging and epidemic-prone diseases is ever-present," Chan said in the Palais de Nations. 

"Constant mutation and adaptation are the survival mechanisms of the microbial world," she said. "It will always deliver surprises."

But while Chan publicly thanked China for "collecting and communicating such a wealth of information" on H7N9, she made no mention of how Middle Eastern governments have responded to MERS. Thirteen months after the first known cases, the world still has very little information about this deadly virus, which has now killed 20 people and infected at least 31. A recent outbreak in the eastern part of Saudi Arabia — the country where the majority of cases have been reported — has also infected 22 people and killed nine, and very little is known about these latest cases.

There are no specific events at the World Health Assembly dedicated to discussing the coronavirus (update: according to this Saudi Gazette report, Saudi Arabia has requested that coronavirus be discussed in Geneva this week) but on Monday morning, I sat down briefly with the pleasant and soft-spoken Dr. Tony Mounts, WHO's technical lead on the coronavirus, to talk MERS — what we know about it, what we don't know, and how worried we should be. 

How concerned are you about the novel coronavirus? 

So far, the mitigating feature is we haven't seen this spread beyondhealth care facilities and close family, except for the two cases that were recently announced. So that’s reassuring — that it’s mostly a hospital-based outbreak among people that may have increased susceptibility.

There are a few things that have been happening recently that I think raise our level of concern. If this was just a hospital outbreak, that would not be so concerning. We’ve seen that before — we think the Jordan cluster back in April 2012 was probably a hospital outbreak that burned itself out and did not extend beyond the hospital. 

But here you also have cases that are showing up in other countries; you have a case in France and local transmission in France. Again, it seems to have limited itself to the hospital setting but to see it spread to other countries like that is a real concern. There are a lot of workers from the Indian subcontinent and the Philippines working in the Middle East — people are also going back to some of these areas where there may not be the same facilities for picking up cases.

So my concern is that there may be travelers who are taking this back to Karachi or to Delhi or to Mumbai or Manila who are not being detected and you could have local transmission in those settings and it wouldn't be discovered until it's spread quite far.

What do we know so far about the possible source of this virus?

Still, we don’t know any more than we did in the beginning. The genetics of the virus make it look like a bat virus. But today, in spite ofquite a bit of work going on to try and find the sources, nobody's been able todemonstrate the virus in an animal species. We think it must be an animal virus — it just doesn’t make sense that this would be a human virus circulating for a long period of time undetected. We just haven't been able to find the animal; there's no smoking gun.

WHO experts recently went to Saudi Arabia to help investigate the recent outbreak. What did WHO learn?  

We came back with some idea of what the government is doing — theextent of the acitvities and intensity of the investigations that are going on. The (WHO) participants, when they returned, they were actually fairly reassured thateverything is being done that possibly could be done to investigate the causes of this outbreak and try and find the source. The (Saudi Arabian) ministry of health and the hospital where thisoutbreak was based had instituted some measures that seem to be stopping thetransmission that was occurring in the hospital. So that was reassuring.

Can you describe some specific measures being taken in Saudi Arabia?

The results of their earlyinvestigation indicates this is a nosocomial outbreak, meaning it's spread within the hospital environment. So they're doing thekinds of things you’d normally do with a hospital outbreak: spacing the patientsa little more, doing isolation when somebody has respiratory symptoms, trying to bemore rigorous about all of the infection control practices ... they've instituted all of these things and as you know, they've invited people from the outside — a hospital infection control specialist from Canada — who's helping to advise them on the specifics of the interventions. It does seem to have stopped the transmission in thehospital.

Why is there still so little known about this novel coronavirus?

I think the investigation is still going on and they’restill trying to collect and collate all of the information. The story we gotfrom the (WHO) mission that returned is that the Saudis feel a little bit likethey’re drinking from a fire hose — it’s just a huge amount of information that they’vebeen collecting in a very short period of time and they just haven't had the time tocompletely analyze and put it all together in summaries.

We have every expectation that they’re going to putthis (information) together and share it with the world.

Some have raised concerns about a lack of transparency around the sharing of information about the coronavirus. Do you share these concerns?

(Saudi Arabia) has sharedinformation about the cases when asked and they've notified us of new cases when theyoccur. So they are fulfilling all of the obligations under the International Health Regulations but we do need this additionalinformation to really understand the threat that this virus poses. The biggestquestion we need to know is what kind of exposures are happening that cause people to get infected; what are people doing, what are they coming into contact with, what are they eating or doing thatresults in infection. 

The Saudis are giving us information. We would like more ofit. Hopefully we’re working a bit more closely with them during the World Health Assembly andhelping them understand what we need. I think that they’re starting to wrap upsome of their early investigations; I’m hoping some of that information willbecome available very soon.

There have been some reports following the recent outbreak in Saudi Arabia that the coronavirus has mutated — can you confirm that?

We haven’t seen the virus from this outbreak. There’s no genetic sequencing from this outbreak. I presume it’s being sequenced but it takes some time. 

How similar is the current novel coronavirus situation to the early days of SARS?

There’s a limited amount of information about thevery beginning of SARS so we don’t really know what happened leading up to when itbecame very public and very evident. There are some similiarities — the type ofillness it causes is similar, although of course the virus is in the same family. But we’re not seeing the kind of easy transmissions with thisvirus that we saw in SARS.

Are there serological studies currently underway?

The Jordanians have just completed an investigation usingserology of their cases that happened a year ago. We’re expecting the results from that study in the next couple of weeks. 

In that initial cluster, we only had twoconfirmed cases — there were about a dozen people that had a similar illness but there were only clinical materials remaining to betested from two or three people. So what they have to do now is go back and draw blood from all of those people to see if theillness that they had was actually this infection. 

The coronavirus is not on the official agenda this week at the World Health Assembly. Do you expect it to come up?

A lot of what happens at formal meetings like this is a lot of the work actually gets done at informal sites — at coffee time and at lunch time. I know there are lots and lots of those kinds ofmeetings going on and lots of discussions. So even if it isn't raised formally onthe floor of the plenary session, there are lots of discussions with the Saudis and other countries in the region. There’s already been somediscussions around the need to ramp up and increase the level of surveillance in other countries in the Middle East and try to get lab capacity up to speed in other countries so they can detect the virus. There’s no reason to expect that this virus is limited toSaudi Arabia.

What would it take for you to start really getting worried about the coronavirus situation?

The biggest warning sign would be onward transmission. Right now the only places that we’ve seen human-to-human transmission is two settings; one is the hospital, and one is close family members. We've had several clusters like that ... local transmission where contact is very close, where there are factors that facilitate transmission of viruses between people — but we’ve not ever seen that extend beyond that, to transmit onward into the community. So the minute we see transmission occurring in a setting that doesn’t normally facilitate transmission, that would be a concern.

This interview has been edited and condensed.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. This week she is blogging from Geneva, where she is attending the World Health Assembly under a UN Foundation press fellowship. Follow her on Twitter: @jyangstar

http://thestar.blogs.com/worlddaily/2013/05/a-sit-down-chat-with-who-coronavirus-expert.html

Health official assures coronavirus is non-transmissible between humans

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  Dr. Ziad Al-Memish, undersecretary to the Ministry of Health for Public Health, addressing a news conference held in Riyadh.

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MOHAMED RASOOLDEEN

Wednesday 7 November 2012

Last Update 7 November 2012 4:38 am

RIYADH:A senior official from the Ministry of Health (MOH) stated on Monday that there is no cause for alarm regarding the detection of a coronavirus case in Riyadh, early this week. 
Undersecretary to the Ministry of Health for Public Health Dr. Ziad Al-Memish told a news conference in Riyadh on Monday that people do not need to worry about the outbreak of coronavirus. He further added that the virus is not transmissible from one person to the other. However, people need to be made aware of the presence of the virus, to take preventive measures to safeguard themselves and their families. 
On Sunday, the MOH announced that it diagnosed a resident in Riyadh as a positive carrier of coronavirus. The tests were confirmed when the sample from the patient was sent to a reputable overseas laboratory. 
A team of specialists in relevant fields also took part in the press conference. 
Speaking to the press, Al-Memish said that upon detecting the virus, the MOH took all preventive measures to contain the virus. “The patient is being treated according to the scientific measures spelt out by the World Health Organization (WHO), and has shown positive indications of recovery. 
“We are also monitoring the virus in all parts of the Kingdom through the regional directorates of the MOH,” he added. 
Al-Memish, who is also the chairman of the National Scientific Committee for Infectious Diseases, said that only a few people in the world have been diagnosed with the virus. 
He further added that the Kingdom has coordinated with international health bodies, including the WHO, to stay up to date with the latest developments concerning coronavirus and other viruses. He also pointed out, that the ministry set up a national committee, comprising specialized consultants representing health sectors in all relevant fields.  
At the beginning of Haj season, coronavirus was detected within two patients in the Kingdom. 
Coronaviruses are considered to be one of the common etiological agents of the common cold. Symptoms of the virus include a runny nose, mild sore throat, cough, headache, low fever and chills. The virus can also cause respiratory, intestinal and neurological ailments. Officials advise people to contact their doctors if the symptoms persist for more than two days.
The official also reassured that coronaviruses are treatable and most patients recover completely without enduring any further complications after receiving the needed supportive therapy. 
Al-Memish said that the Kingdom’s health officials are well equipped and experienced in dealing with infectious diseases. He further stressed the importance of early detection to ensure a quick recovery. He pointed out that 95 percent of the patients recover fast without any problems. 
Dr. Ali Bin Mansour Al-Barrak, member of the National Scientific Committee for Infectious Diseases, stated that the MOH has circulated a memo outlining the signs and symptoms of the disease, to all the hospitals in the Kingdom. 
Sami Ben Hussein Hajar, a consultant at King Faisal Specialist Hospital and Research Center, added that so far the virus has not afflicted any children in the Kingdom. 
The virus can be fatal, especially among the elderly and in patients with chronic respiratory and cardiac conditions, as well as immunity compromised

Man dies of flu-like illness

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