9 MERS-CoV cases. Possible healthcare cluster

Saudi Arabia's health ministry reported 9 more Middle East respiratory syndrome coronavirus (MERS-CoV) cases over the past 2 days, at least 4 of them in health workers, along with 2 more deaths, 1 of them apparently involving a male nurse whose illness was announced last week.

According to a machine translation of a Saudi Ministry of Health (MOH) statement yesterday, an investigation of 356 samples of patients and contacts over the past week yielded positive samples for three health workers, all of whom were in stable condition or asymptomatic. The MOH said a doctor working in Jeddah is now healthy, but it's not clear if the doctor is one of the three health workers who tested positive for MERS-CoV.

The statement also reports the death of a health worker, who appears to be a 26-year-old from Jeddah whose illness was first announced by the MOH on Apr 1. At that time the MOH said the patient was in the intensive care unit.

In a separate announcement today, the MOH confirmed four more cases from Jeddah. They include a 28-year-old man who is hospitalized in intensive care, a 32-year-old health worker who has no symptoms, and two more adults ages 35 and 33 who are asymptomatic.

Infected health workers
MERS-CoV illnesses in healthcare workers has been a hot button issue in Saudi Arabia, and the MOH announced last week that it would pay a special monthly allowance to health workers who are routinely exposed to highly infectious diseases. According to earlier media reports, healthcare workers recently demanded the extra pay after a male nurse working at King Abdulaziz Hospital in Jeddah was diagnosed as having MERS.

The World Health Organization (WHO), in an overview last month of recent MERS-CoV cases and medical literature reports, raised concerns about continued transmission of the virus between humans in healthcare settings.

The agency said hospital-based transmission from unrecognized primary cases seems to be occurring, with infections spreading to other patients, and that nosocomial illnesses are likely to continue unless hospitals rigorously follow appropriate infection control practices.

Father-son cluster
The two other cases reported yesterday include a 70-year-old man from Jeddah who had an underlying health condition and died of his infection. Screening of the man's household contacts revealed a second infection, his son, who was asymptomatic.

Though some of the details about the number of cases are unclear, the MOH posted new totals on its Arabic-language media statement page that reflect 175 infections, an increase since Apr 2 of 9 cases.

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