Saturday, May 17, 2014

Third US MERS Case is Home Grown

An Illinois man is the first domestic MERS case in the USA
A man from the US state of Illinois contracted the Middle East Respiratory Syndrome virus (MERS) from a previously confirmed case, marking the third MERS infection in the USA and the first confirmed person-to-person transmission in the country, according to this statement from the Center for Disease Control and Prevention (CDC).

The man had contact in business meetings on two occasions with an Indiana man, the first US case, who had recently returned from Riyadh, Saudi Arabia where he was a health care worker.

During the meetings, the men were in close proximity, within 6 feet of each other and met for 30 to 40 minutes. They reportedly shook hands.

The man in the newest case originally tested negative for the virus but further testing proved he had previously been exposed and recovered without becoming ill. He might have experienced a slight runny nose, but it is unknown if it was related to the illness.

"These laboratory test results are preliminary and suggest the the Illinois resident probably got the virus from the Indiana patient, said the CDC statement, "the person's body developed antibodies to fight the virus. "It's possible that as the investigation continues others may also test positive for MERS-CoV infection but not get sick."

The news is both good and bad. It may be that MERS is easier to transmit than believed, but less virulent than feared.

Family members and caregivers have been considered most at risk from secondary infections, but it may be that more casual contact can spread the virus. MERS may be more transmissible than thought, but many infected could display few or no symptoms of disease.

"There is evidence that there is a broader spectrum of illness with MERS than was initially suspected, that there can be no symptoms," said the MERS Incident Response Manager for the CDC, David Swerdlow, "That could be because only those with severe cases have been tested for the virus up until now."

The Illinois man is isolating himself and wearing a mask as health officials screen his contacts for signs of MERS.

MERS-CoV has sickened hundreds of people worldwide, and approximately a third of those confirmed with the illness have died. The vast majority of those infected had ties to Saudi Arabia or another country in the Arabian Peninsula where the disease has been found.

Symptoms of the virus include fever, cough and shortness of breath in a person who has recently travelled to the Middle East or had contact with someone who travelled there.

Some victims suffer from diarrhea and nausea and vomiting. Severe cases can result in pneumonia and kidney failure. Most of the people who have died from MERS suffered from some kind of underlying medical condition or weakened immune system.

The CDC reiterated its' advice to the general public for avoiding MERS and other contagious diseases: wash hands regularly, avoid touching your face, avoid contact with people who appear sick and disinfect frequently touched surfaces.

Travellers have not been advised to alter their plans but the region is currently under a Level 2 Alert from the CDC. This means visitors should "Practice enhanced precautions"

If visiting countries in or near the Arabian Peninsula, be alert to your health during and after your trip.

Make sure your immunizations are current. Be sure to visit a doctor promptly if you develop a fever, shortness of breath or cough within 14 days and be sure to tell your doctor about your recent travel.

More information for travellers on MERS in the Arabian Peninsula from the CDC is available here.

Friday, May 16, 2014

Netherlands Sees First MERS Cases

The Netherlands is the sixth European country to report MERS
The Netherlands has reported it's first and second cases of Middle East Respiratory Syndrome (MERS) in a pair of residents who had recently returned from Saudi Arabia.

The Dutch couple arrived in the Saudi Kingdom on April 26. Both suffer from pre-existing medical conditions.

The 70 year old man developed symptoms on May 1 while in the city of Medina. He visited a hospital emergency room in Mecca on May 6 where he received antibiotics.

He did not develop respiratory problems until his return to the Netherlands where he was hospitalized on May 10. He tested positive for the MERS virus three days later. Both victims are currently hospitalized in stable condition.

One of the two victims may have visited a camel farm while in Saudi Arabia. Close contacts of the pair, including fellow passengers on their flight, are being notified for monitoring and testing.

Thirteen of the 614 laboratory confirmed cases reported to WHO have occurred in Europe and all had recently travelled from the Middle East or had close contact with someone who had.

Previous European cases have been reported in France, Germany, Greece, Italy and the UK. Imported infections in Malaysia and the Philippines brought MERS to Asia.

Africa has reported cases in Egypt and Tunisia and the North America has seen two cases in the US. Most had direct links to a Middle Eastern country where MERS has been reported, including Jordan, Kuwait, Oman, Qatar, Saudi Arabia, UAE and Yemen.

The World Health Organization currently reports 614 laboratory confirmed cases of MERS worldwide, with 181 deaths.

Two Suspected Orlando MERS Cases Test Negative

 May 16, 2014

MERS Corona virus
Two ill hospital workers who had contact with a confirmed Middle East Respiratory Syndrome (MERS) patient have tested negative for the disease, according to Orlando hospital officials at a news conference yesterday. One of the suspected victims had required hospitalization.

The suspected cases had contact with an Orlando man who became ill with the virus en route to Florida from Jeddah, Saudi Arabia, where he is a health care worker and has worked with MERS victims.

Both developed flu-like symptoms after caring for the man at Dr P Phillips Hospital where he sought treatment on May 8.

A total of twenty hospital staff from two locations have been furloughed for two weeks and the remaining eighteen are undergoing testing. The man's family members are also isolated at home while being screened for the virus.

The infected man, the second case in the US, travelled from Jeddah to London then through Boston and Atlanta en route to Orlando, Florida on April 30. He developed a fever, chills and slight cough during the flight. Health officials are seeking approximately 500 fellow passengers who may have had contact with him on en route.

The man also accompanied a friend to the Orlando Regional Medical Center on May 5 on an unrelated matter. Five of the furloughed health care workers who are currently being tested are from that facility.

Media reports the man waited four hours in a crowded hospital emergency room before he was seen by a doctor and an additional eight hours passed before the possible MERS case was identified and the man was placed in isolation.

According to the World Health Organization, about a quarter of new MERS infections occur in health care workers and they account for the majority of secondary infections.

Hospitals have been the source of several MERS clusters, including large outbreaks in the cities of Jeddah and Riyadh. WHO blamed the outbreaks on 'breaches' in infection control protocols by medical staff.

To date, the Saudi Ministry of Health reports 520 cases of MERS and 163 deaths in the Kingdom. Hundreds of cases have been reported in the last six weeks, including more than 150 new infections since May 1.

Despite replacing the Director of King Fahd Hospital in Jeddah, increased emphasis on infection control procedures and a recent visit by a team of WHO specialists, health care workers continue to spread the virus.

The man, a health care worker from Jeddah who was directly exposed to MERS patients, did not wear a mask despite developing a fever and becoming ill during travel. He did not seek treatment on arrival in Florida, instead visited a local hospital with a friend on an unrelated matter.

Three days later he sought treatment at another hospital where he spent hours in a crowded emergency room and hours more before his travel history raised concern about the MERS virus and he was finally isolated.

Despite repeated pleas from WHO and worldwide concern, this single health care worker could have exposed hundreds of people over several continents before he was quarantined.

He knew he had been exposed to MERS in Jeddah and may have been feverish and contagious for a week before presenting himself at an Orlando emergency room.

The Orlando medical facility dropped the ball by allowing him to come in contact with so many others for so many hours before realizing the risk he posed.

Health care workers must take personal responsibility for the risks they may pose to others through the course of their work. Hospitals must train staff to isolate potentially contagious patients more quickly and recognize less common diseases.

This is especially vital in cities with large numbers of international visitors, like Orlando, home to Disney World, Universal Studios and many other popular tourist destinations.

Health care workers are the first line of defence against emerging and established infectious diseases. The public must be able to count on them to prevent dangerous illnesses from migrating from hospitals to homes.

With the explosion of new cases, especially in previously unaffected countries, and inconsistent infection control procedures in health care facilities, the world could be witnessing a MERS pandemic in the making.

Monday, May 12, 2014

Second MERS Case Confirmed in US

Dr. P Phillips Hospital in Orlando, Fl;
Site of second US MERS case. (image from g+)
A second imported case of Middle East Respiratory Syndrome has been confirmed in the US.

A 44 year old man visiting family in Orlando, Florida has been hospitalized after travelling from Saudi Arabia where he is employed as a health care worker. He is reportedly in stable condition and improving.

The man flew from Jeddah on April 30 via London, then through the US cities of Boston, Massachusetts and Atlanta, Georgia before arriving in Orlando, Florida on May 1.

The man reportedly showed symptoms on the flight, including a  fever, slight cough and chills but did not wear a mask. A week later he sought medical treatment for the illness at the Dr. P Phillips Emergency Room in Orlando.

Sixteen hospital workers who may have been exposed to the virus are on paid leave and asked to remain at home. The man's family has been placed in quarantine.

The flight numbers he travelled on have not been released, but officials are attempting to reach approximately 500 fellow passengers who may have been in contact with the man en route to the US cities.

"Our experience with MERS so far suggests that the risk to the general public is low, said Tom Frieden of the US Centers for Disease Control and Prevention (CIDRAP). But stressed that, "We're doing everything possible to find others who had contact with this person. 

MERS patients often develop symptoms within five days but they can present up to fourteen days after exposure. Since it has been nearly two weeks since he travelled, exposed contacts would have probably shown signs by now.

According to Dr. Anne Schuchat, Assistant Surgeon General, "It's likely if you haven't developed symptoms yet, you're not going to."

Local residents who have concerns about MERS can reach a dedicated Health Department Hotline at 407-858-1490.

The first US MERS case involved an Indiana man who also was a health care worker and had recently travelled from Riyadh, Saudi Arabia. The man has since recovered and has been released.

MERS was first identified in April of 2012 and most cases have originated in the Arabian Peninsula, with Saudi Arabia the hardest hit.

The World Health Organization says 229 new cases were reported in Saudi Arabia between April 11 and May 4. The Saudi Minister of Health reports 491 cases of the virus to date in the Kingdom, 147 of those have died.

Jordan has reported three additional cases this month and three new countries were added to the list where MERS has been found.

Egypt, Yemen and the US all reported their first MERS patients in the last few weeks. All had recently traveled to the Middle East and most had direct links with Saudi Arabia. shows sixteen countries have reported MERS infections. Here is an unofficial count of MERS infections by country:

Saudi Arabia: 491 cases / 147 deaths
UAE: 56 cases / 7 deaths
Qatar: 9 cases / 4 deaths
Jordan: 8 cases / 4 deaths
Kuwait, Tunisia: 3 cases each / 0 deaths
Italy, UK, US, Oman, Egypt: 2 cases each / 1 death in UK
Lebanon, Yemen, France, Greece, Malaysia: 1 case each / 1 death in Yemen

This makes a total of 585 cases worldwide, with 164 fatalities or about 28% of those infected.

Wednesday, May 7, 2014

Saudi MERS Infections Top 400: 88 Cases This Week

The MERS virus
The first week of May has seen 88 new MERS infections announced by the Saudi Minister of Health and another death from the virus in Jordan.

The grim total in the Saudi Kingdom has reached 449 infections with 121 deaths. The daily reports by the Ministry of Health shows:

May 1:  10 new cases
May 2:    7 new cases
May 3:  18 new cases
May 4:  15 new cases
May 5:    3 new cases
May 6:    7 new cases
May 7:  28 new cases (reported in two announcements, 18 and 10 new cases)

Male and female victims were nearly equal with 46 men and 42 women confirmed this week.

About a third of cases (30%) are asymptomatic, or without symptoms, a third are in stable condition (35%) and a third are in intensive care units (32%). Fourteen people died from the virus this week, all but one were previously confirmed cases.

The director of King Fahd Hospital in Jeddah has been replaced as the city announced 30 new cases this week. According to the Health Ministry, the change would result in an "immediate improvement" in the medical care at the facility.

Riyadh saw 28 additional infections this week. Infections are rising in Mecca with 13 and Medinah with 7 this week. The cities of Najran and Al Taif each saw one case.

The announcements did not specify how many of the newly infected were health care workers, a sector which has been particularly hard hit by the virus.

Reuters reports that WHO estimates a quarter of new cases are among health care providers and they account for the majority of secondary infections.

"There was a clear need to improve health care workers' knowledge and attitudes about the disease and systematically apply WHO's recommended measures in health care facilities."

Dr. Mohammed Al Ghamdi, infectious disease consultant for King Fahd Hospital, tells WHO, “Our priority is to stop the transmission inside the hospital by strengthening infection prevention and control activities. WHO is helping us in getting answers on transmission routes not only in health facilities, but also in the community.”

The World Health Organization has sent a team of experts to Saudi Arabia to investigate the cause of the sudden surge of cases in the Kingdom.

WHO blames recent outbreaks of the virus at two Jeddah hospitals on "breaches" in recommended infection control measures.

Researchers attribute the increase in MERS cases on improved contact testing and reporting and to seasonal changes. They do not feel the virus has become more transmissible.

Friday, May 2, 2014

MERS in the US: Indiana Man Tests Positive for Coronavirus

An Indiana man has tested positive for the MERS virus
An American man has tested positive for the MERS virus in the state of Indiana, according to the Center for Disease Control and Prevention, who confirmed the test results on Friday.

The man, who is a healthcare worker, had recently traveled to Saudi Arabia where he had worked as a healthcare provider.

On April 24 he flew from Riyadh to London and then on to Chicago in the US. He took a bus to Indiana where he is currently hospitalized in stable condition and in isolation.

New cases of MERS have also been reported in Greece, Yemen, Malaysia and the Philippines in recent weeks and there have been conflicting reports of the virus in Egypt. All the exported cases had direct links to the Arabian Peninsula.

Update 05/03/2014: WHO has confirmed MERS in an Egyptian man who had been living in Riyadh, Saudi Arabia. He had contact with two previously confirmed MERS patients and is in stable condition in an Egyptian hospital. 

Saudi Arabia has reported the highest number of cases with 378 currently announced by the Ministry of Health and 107 deaths or 28% of those infected.

MERS has doubled in the Saudi Kingdom just in April, including 39 new cases in the last three days. Officials have attributed the rapid increase in reported cases to better reporting and 'warmer weather'.

Experts feel the risk of a worldwide MERS pandemic is low as the virus does not seem to be easily transmissible between humans and secondary infections tend to be less serious.

According to Anne Schuchat, Director for the National Center for Immunization and Respiratory Diseases and Assistant Surgeon General for US Public Health, MERS has shown a "very low risk to the broader general public."

CIDRAP and the World Health Organization have been monitoring the virus since it first appeared in the Middle East two years ago.

Schuacht said officials have been expecting that MERS would reach the US eventually. "We've been preparing for this," as she cautioned that MERS in the United States is "another reminder that diseases are just a plane ride away."

Saturday, April 26, 2014

Egypt Reports First MERS Case as Saudi Toll Climbs Again

An Egyptian man is hospitalized in Cairo with MERS
Egyptian State TV is reporting the first case of MERS in Egypt, the fifth nation this month to report initial infections with the deadly virus. The announcement comes as Saudi Arabia reported 14 more cases today with four deaths.

A 27 year old Egyptian man is being treated for pneumonia and in stable condition in a Cairo hospital after he was diagnosed with MERS.

The man had recently returned from Saudi Arabia where he had been living in Riyadh, the location of numerous recent MERS infections.

This month has seen new MERS infections in Greece, Yemen, Malaysia and the Philippines. The spread of the virus into new locations comes as the Arabian Peninsula has seen a sharp increase in cases, especially in Saudi Arabia and the UAE.

Fourteen new cases were reported in Saudi Arabia today, a continuation of a week which has seen new infections reported nearly every day and brings the grim total to 323 cases in the Saudi Kingdom and 94 deaths. 83 of those cases have been reported in the last week. April alone has seen 102 infections with 22 deaths in the Kingdom.

In the latest announcement by the new Saudi Minister of Health, Riyadh reported four new cases of the virus, including one death. Mecca reports three new infections and one fatality. Hard-hit Jeddah reports seven additional cases and three deaths. Four of the cases are workers in the health care sector, including a nurse without symptoms from King Fahad Hospital in Jeddah.

Four of the cases are asymptomatic (without symptoms), four are hospitalized in stable condition and two victims are in intensive care units.

Friday, April 25, 2014

Has MERS Reached a Pandemic 'Tipping Point'? WHO Raises Alarms; Saudi Totals Spike Again

April has seen a sharp increase in MERS infections. (image from CDC)
The World Health Organization is raising alarms about the sudden jump in the number of cases of Middle East Respiratory Syndrome (MERS) in Saudi Arabia and the UAE in the last few weeks, as health officials speculate whether the virus has reached a 'tipping point' where it could break out of the Middle East and become a global pandemic.

It took MERS two years, since it was first identified in April, 2012, to top 200 cases. Barely two weeks ago, WHO listed 211 infections and 88 deaths from the virus worldwide.

Saudi Arabia alone is currently reporting 313 cases and 93 deaths. The New York Times states there have been four deaths and 36 cases reported there in the last 24 hours, including a Turkish pilgrim who had visited Mecca.

As the number of cases grows, so do the countries where MERS has been found. Malaysia, the Philippines, Yemen and Greece have all reported their first infections and in all cases the victims had recently traveled to the Arabian Peninsula.

The United Arab Emirates has reported 45 cases and 7 deaths. Half (23) of those infections have occurred since April 1.

Jordan has reported an additional case involving a 25 year old man from Al Grayat City who had recently traveled to Saudi Arabia and had contact with camels and drank camel milk. This makes five cases and three deaths in that country.

WHO states that three quarters of the recent infections were secondary cases, that is, they caught the virus from another person. Most of these secondary infections have occurred in health care facilities, with the virus being passed to healthcare workers and other patients who were being treated for unrelated illnesses.

Most of the new cases have been been mild or asymptomatic (without symptoms) and secondary cases are less likely to spread the virus but health officials caution that much is still unknown about how MERS is transmitted or the route of infection.

WHO has offered to assist Saudi Arabia and the UAE in investigating the outbreaks and chain of transmission. They hope to determine if there is an 'evolving risk' that could be contributing to the uptick in infections.

According to Dr. Michael Osterholm of the Center for Disease Research and Policy (CIDRAP) via NPR, the disease may have "reached a tipping point and could be ready to spread out of the region." He cautioned that, "It took us over a year to get the first hundred cases of this viral infection, now in just the last two weeks, we've had a hundred cases. ... There's a major change occurring that cannot just be attributed to better case detection. Something's happening."

MERS is believed to be less contagious but more deadly than it's famous cousin SARS which sickened thousands worldwide and continues to circulate in some populations. The MERS virus has claimed the lives of 30 - 50% of victims, a staggeringly high mortality rate.

As concerns grow that the virus may have mutated to a form which is more easily transmissible among humans. Dr. Osterholm is worried we have may have already crossed that line. "When humans readily transmit [a virus] to humans, that's what will cause a worldwide outbreak," Osterholm says. "We are very concerned that ... with what we've seen over the last two weeks ... we may be at that point now."

Twelve New Cases Reported in Saudi Arabia Today
The alarming jump in infections in Saudi Arabia continues today with the announcement of 12 new MERS cases and two deaths from previously confirmed infections.

The statement includes details of the newest cases, six in hard-hit Jeddah, five in Riyadh and one from the holy city of Mecca.

Five of those infected are in area ICU units, six are in stable condition and one is asymptomatic (without symptoms).

Nine men and three women are included in today's announcement. Health care facilities continue to be the venue for many of the infections, with nearly half coming from that sector; One doctor, two nurses, a receptionist and a patient admitted for an unrelated illness were likely exposed to MERS at Saudi Hospitals.

The deaths were a 68 year old man from Mecca and a 72 year old woman from Riyadh.

The Saudi Ministry of Health has currently confirmed 313 MERS infections in the Kingdom and 92 deaths.

Thursday, April 24, 2014

UAE Reports Nine More MERS Cases

Nine new MERS infections reported in Abu Dhabi, UAE
The United Arab Emirates' Ministry of Health has reported nine new MERS cases. This continues a month outbreaks, clusters and three additional countries where MERS has been found.

All of the cases announced today are from the Abu Dhabi area and none have traveled or been exposed to animals recently.

According to Infection Control Today, six of the cases involve a cluster who were exposed to a laboratory confirmed case on April 10. They are currently being held in isolation and testing of family members and health care workers is continuing.

The members of this cluster range from 28 to 59 years old. Four have mild symptoms, the other two show no symptoms. The group is evenly divided between men and women.

The three remaining cases are all women between 52 and 73 years old. All have underlying medical conditions.

Two appear to have been exposed while visiting hospitals. One was an in-patient at an Abu Dhabi facility for an unrelated illness and is currently in ICU and the other had visited a hospital in Jeddah, Saudi Arabia three times during a recent trip.

The last case reported is a 63 year old woman who is a close contact of a previously confirmed case.

The UAE has reported 45 MERS infections to date.

Wednesday, April 23, 2014

Saudis Report 36 New MERS Cases in Just 3 Days

36 new MERS cases reported in last 3 days;
61 new infections since April 1. Saudi MoH 
In a shocking jump in MERS cases in Saudi Arabia, the Ministry of Health has announced an additional eleven infections today, raising the number of new cases of Middle East Respiratory Syndrome in Saudi Arabia by 61 since the beginning of April, including 36 infections in just the last three days.

On April 20, health officials reported thirteen cases, on April 21, twelve new cases were announced, plus five close contacts and the death of a previously announced MERS patient. April 23 brought the announcement of eleven additional infections.

The eleven cases announced today range in age from 13 to 81 and include five women and six men. Three work in the health care field. Four are from Riyadh, six from Jeddah and one from Mecca. One shows no symptoms, two are stable and seven are in intensive care units.

The Ministry of Health website currently reports 285 cases in the Kingdom, including 83 deaths.

The sudden jump in MERS cases has raised concern that the virus may have mutated to a more easily transmissible form.

Health officials have cautioned the public to be vigilant but not to panic. They stated that a popular rumor that all large public gatherings have been cancelled is untrue and the public should not believe rumors being spread on social media websites.

Monday, April 21, 2014

Greece Reports First MERS Case

Greece has reported the first case of MERS in the country
The World Health Organization in Europe has reported the first case of laboratory confirmed MERS in the country of Greece.

The 69 year old Greek citizen has been residing in Jeddah, Saudi Arabia. He visited a Jeddah hospital on April 8 and 10 for probable Typhoid Fever and visited his wife who was hospitalized between March 31 and April 5 with confirmed Typhoid Fever.

Jeddah has been plagued by several recent outbreaks of the MERS virus and health care settings have been the source of the majority of new cases.

The Emergency Department at King Fahd Hospital was briefly closed while staff disinfected following MERS clusters linked to the facility. Today's report did not specify which Jeddah hospital he visited.

The man returned to Greece on April 17 and was examined at a local medical facility where he was diagnosed with bilateral pneumonia. MERS was confirmed by the National Reference Laboratory for Influenza.

He is currently in stable condition. Close contacts of the man from the plane, hospital and community are being being sought. None have become ill so far.

Greece makes the fifth European country which has reported MERS infections. The others include UK, Germany, France and Italy. A total of ten cases have now occurred in Europe, five of which have died. All had recently traveled to the Middle East or had close contact with someone who had vistied there.

A sharp increase in MERS cases have been reported in the last month, including new infections in Malaysia, the first in Asia and an unconfirmed case in Yemen. A Philippine paramedic with links to a UAE cluster later tested negative for the virus.

The World Health Organization has confirmed 250 cases of MERS worldwide to date, with 93 deaths.

Saudi MERS Count Jumps Again; Filipino Man Tests Negative

April 21, 2014

MERS Infographic from Saudi MoH
In a month which has seen an alarming jump in MERS infections in the Middle East, Saudi Arabia has confirmed thirteen new cases of the deadly virus in the Kingdom, three of which have died.

The Ministry of Health announced that more than a dozen additional cases had been discovered and the victims are from varied regions of the country.

Seven of the latest infections are from the Jeddah area. This region has seen several recent clusters of the virus, prompting the closing of the Emergency Room at King Fahd Hospital last week for disinfection. There are also reports that four doctors resigned after refusing to treat MERS patients.

The Jeddah cases range in age from 23 to 57 years old and include five men and two women. One victim has passed away, one is in the ICU unit, four are listed as 'stable' and one is without symptoms.

No details on the source of the illness is provided, but one of the Jeddah cases reportedly works in the health care field.

Four cases are listed as from Riyadh, including three men and one woman. Three of the victims suffer from chronic medical conditions, two of which are in ICU units, the other is stable.

One Riyadh case reportedly works in the health care sector and is in stable condition.

The last two cases both involve 68 year old men with underlying medical conditions who have passed away. One was from Najran and one was from Medina.

The Saudi Ministry of Health website reports 244 cases of MERS in the country, with 79 deaths. 36 of those infections have been reported in the last five days, raising concerns among health workers and the public.

This and other informative videos are available on MERS symptoms and prevention, produced by the Saudi Health Ministry (Arabic).

Filipino in UAE Cluster Tests Negative
A Filipino man who had been a member of a UAE cluster has tested negative for MERS.

Forty fellow passengers on Flight EY 0424 from the UAE last Tuesday have also tested negative for the virus. The flight carried 415 people, of which 119 have been contacted and 72 tested.

The man and his family had been isolated since he returned from the United Arab Emirates following an outbreak among six paramedics. The man had flown home before the results of a positive screening test were received. They have been released from quarantine following the latest negative result.

Thursday, April 17, 2014

MERS in Philippines Linked to UAE Cluster; WHO Confirms Malaysian Case

Health care facilities have been the source
of the majority of new MERS infections
The World Health Organization has been informed of four more MERS cases originating in the United Arab Emirates.

One returned to his home country of the Philippines where he is in isolation after testing positive for the Middle East Respiratory Syndrome corona virus, commonly known as MERS.

WHO also confirmed a Malaysian man died of MERS after participating in the Umrah Pilgrimage to Saudi Arabia.

The UAE announcement involves four men who worked at a hospital in Abu Dhabi. They were discovered to be infected following routine contact testing of a man who died of the MERS virus on April 10.

The ages of the men range from 28 to 44 and none have underlying medical conditions. One became ill on April 14 and the rest are asymptomatic (without symptoms).

One man returned to his home in the Philippines before test results were received, despite being advised to remain.

According to Enrique Ona, Philippine Health Secretary, he is being held in isolation after testing positive for the virus and is not showing symptoms at this time.

His family has also been quarantined and contacts are being screened for MERS.

This cluster follows the April 15 announcement that six paramedics in the city of Al Ain, UAE had tested positive for MERS and one had died.

These latest cases could raise the total MERS infections in the UAE to 30 and the number of countries where infections have been reported to fourteen.

The Malaysian case is the first MERS infection in that country and in Asia. The man, who reportedly had diabetes, traveled to Jeddah with 17 others for the Umrah pilgrimage on March 15.

While in Saudi Arabia, he is reported to have visited a camel farm and drank camel milk. He returned home on March 28.

He became ill on April 4 and visited a private clinic on April 7. He was admitted to the hospital on April 9 and passed away on the 13th.

Dr. S Subramaniam, Health Minister is urging passengers who flew on Turkish Airlines flights TK93 and TK60 to contact the Health Ministry for MERS screening.

MERS was detected in three more countries this week with today's report from the Philippines and recent announcements from Malaysia and Yemen. All cases have had direct links to the Middle East and health care workers appear to be especially at risk.

WHO has now confirmed 243 MERS cases and 93 deaths worldwide.

Wednesday, April 16, 2014

MERS in Asia: Malaysian Man Dies After Pilgrimage to KSA

Malaysian officials report first MERS case in Asia 
The MERS virus has claimed it's first victim in Asia, with the announcement that a 54 year old Malaysian man has died of the disease.

The man, who suffered from diabetes, had recently returned from pilgrimage in Saudi Arabia. He was admitted to the hospital in Johor with breathing problems, fever and a cold after returning home and passed away on April 13.

According to Dr S Subramaniam, Malaysian Health Minister, "We have to take this condition very seriously because of the high incidence of death and it's a viral infection. We don't have a specific treatment for it."

The man traveled aboard a Turkish Airlines flight on March 29 and fellow passengers are being contacted by the Health Ministry for MERS testing.

This report follows yesterday's announcement of the first case and fatality in the country of Yemen and a week of outbreaks in Saudi Arabia and the United Arab Emirates.

Malaysia makes the thirteenth country to report MERS cases. The others include Saudi Arabia, UAE, Qatar, Jordan, Oman, Kuwait, UK, Germany, France, Italy, Yemen and Tunisia.

The World Health Organization recognizes 212 laboratory confirmed cases and 88 deaths from the virus. Saudi Arabia has suffered most with 185 infections and 68 fatalities.

image from

Tuesday, April 15, 2014

Yemen Reports First MERS Death

Yemen has reported their first death from the MERS virus
A resident of Yemen, in the city of Sana'a, has died of the MERS virus, according to Deputy Health Minister, Nasser Ba’awn.

No information regarding possible method of exposure was provided, including travel or exposure to animals.

Abdulhakeem Al-Kuhlani, director of the Epidemiological Surveillance and Disease Control Department at the Health Ministry, said they would take urgent action to raise awareness about the virus’ symptoms and ways to avoid infection.

The report states the World Health Organization, working with the National Center for Epidemiological Surveillance, has sent in a team to investigate and take samples from contacts.

Six UAE Paramedics Contract MERS; More Infections Linked to Jeddah Hospitals

April 15, 2014

King Fahad Hospital in Jeddah
Health workers continue to suffer the biggest risk of contracting the MERS virus, with a cluster of six paramedics in the UAE and two more health workers exposed to the virus in Jeddah in the latest Saudi cluster, according to the latest CIDRAP report.

The UAE, second only to Saudi Arabia in MERS infections with 27, announced a worker for an ambulance service in the city of Al Ain had died of MERS and five of his co-workers have been infected with the virus.

They are currently in isolation as the ambulance company searches for the source of the outbreak and traces previously transported patients for a possible MERS link.

Jordan has reported it's fifth MERS infection with the announcement of a 52 year old man who had chronic medical conditions and had traveled to Saudi Arabia between March 20 and 29.

He reportedly visited a hospital in Jeddah, Saudi Arabia when he became ill on March 25. He visited the hospital again in Amman when he returned to Jordan and was finally admitted when he arrived at the hospital for the third time on April 2. He is currently in stable condition.

Saudi Arabia has reported a new cluster in Jeddah, involving two health care workers and a 45 year old who has passed away.

This latest outbreak follows a week of multiple MERS cases linked to King Fahd Hospital in Jeddah. The Saudi Health Ministry reports 11 confirmed cases while local media is reporting the number is 15, including three doctors and four nurses.

The spike in cases forced the hospital's Emergency Department to close for 24 hours last week for disinfection and officials consider hazard pay for health workers caring for MERS patients.

The grim total of MERS victims in Saudi Arabia has reached 185, including 68 deaths.

The World Health Organization reports 212 laboratory confirmed MERS cases worldwide, including 88 fatalities.

Thursday, March 27, 2014

Two More MERS Cases Reported in UAE

UAE is second to KSA in MERS infections with 16 cases and 6 deaths.
Health officials in the United Arab Emirates are advising citizens 'not to panic' following two more cases of MERS in the country.

The UAE is second only to Saudi Arabia in numbers of confirmed MERS cases, with an unofficial count of 16 cases and six deaths.

The most recent infections were announced by the World Health Organization on March 25 and 26.

The first is a 49 year old man from Abu Dhabi who suffers from chronic medical conditions and had been hospitalized on February 27 and released on March 9. He was re-admitted to the hospital on March 16 and laboratory confirmation of MERS was performed on March 19. He is currently in critical condition.

The man reported no contact with animals or recent travel. However, he had contact with a previously confirmed MERS patient on March 1, during his initial hospitalization.

Health care facilities continue to be a major source of MERS infections, with a recent report showing approximately 50% of new cases are contracted there.

The second case announced by WHO is a 40 year old Omani man who also suffers from chronic medical conditions. He had been hospitalized in Muscat in mid-February and later traveled to the UAE, where he was admitted to the hospital in Abu Dhabi on March 17.

MERS was confirmed on March 21 and on the 24th, he passed away. The man reported no contact with animals or other confirmed MERS patients and had only traveled between Oman and the UAE.

According to The National, Dr. Asim Malik, Infectious Disease chief at Mafraq Hospital in Abu Dhabi, reassured the public that the UAE is following WHO and local health guidelines. "There is no reason to panic." He said rigorous identification and reporting systems have resulted in higher case numbers in the country.

"The reason we have been catching the cases is because of the super vigilant system we have adopted in the UAE, as per WHO recommendations and Health Authority-Abu Dhabi guidelines. We have a very strong infection control system. We are fully prepared.”

Dr. Malik stated that the virus does not seem to be evolving or becoming easier to transmit and that the most severe cases have suffered from underlying medical problems. "We have seen no change in the pattern," he said.

"We have had cases in the country who have succumbed to the disease and we have cases that have survived and that is in keeping with the global picture of the disease, which is approximately 40 to 50 per cent mortality."

The World Health Organization has now confirmed 200 cases of MERS worldwide and 85 deaths.

Monday, March 24, 2014

Camels Shown to Pass MERS to Humans

A study by Emerging Infectious Diseases found evidence that humans can acquire the Middle East Respiratory Syndrome virus (MERS) directly from camels, which had been suspected but unproven.

A man who tended to infected camels in Saudi Arabia also became infected and was shown to have a nearly identical form of the virus as the ill dromedarys he was in contact with. This suggests the man caught the virus from the camels.

The authors of the study conclude, "These data add to recent findings showing high similarity of MERS-CoVs carried by humans and camels, supporting the hypothesis that human MERS-CoV infection may be acquired directly from camels. In addition, both animals that showed signs of recent infection were juvenile, which provides further support to previous findings that mainly young animals are infected by MERS-CoV."

image: flickr/Pushkar 2011

Hong Kong Monitors Possible MERS Infection

March 24, 2014

The Centre for Health Prevention in Hong Kong has reported a possible infection with the Middle East Respiratory Syndrome corona virus (MERS).

The 61 year old woman, who suffers from chronic medical conditions, had traveled to Saudi Arabia and was visiting Hong Kong before returning to Indonesia. She arrived at North Lantau Hospital Emergency Department with fever, cough and shortness of breath and was transferred to Princess Margaret Hospital where she is in serious condition.

 Close contacts of the woman have reported no symptoms of the illness.

Preliminary testing will be performed to determine if this is Hong Kong's first case of MERS. A suspected case in December 2013 and two in February, 2014 have all tested negative for the MERS virus.

The announcement stressed that, "No human infection with this virus has been identified so far in Hong Kong," Health officials state that they will continue to monitor public and private hospitals, doctors and the airports for possible MERS infections and be as transparent with the public as possible.

According to a March 20 update, the World Health Organization has been informed of 198 laboratory confirmed cases of MERS worldwide, including 84 deaths.

Friday, March 14, 2014

Five MERS Cases Reported in Riyadh; Possible Family Cluster

Five more MERS cases in Saudi Arabia (
Saudi Minister of Health has announced five cases of MERS in the Riyadh area today. The cases range in severity from asymptomatic to fatal.

Health officials report an 83 year old man who suffers from chronic health problems is in intensive care with the virus.

As announced earlier today, a 19 year old man who also suffered from underlying health problems has passed away.

Two females ages 22 and 18, reportedly sisters of the man who died, are hospitalized with mild symptoms and are in stable condition.

The fifth case is a 53 year old and possible contact of a previously confirmed case. He is asymptomatic (without symptoms).

The Saudi Ministry of Health website reports 156 cases of MERS in the Kingdom and 63 deaths.

Saudi Man Dies of MERS; Possible Family Cluster

MERS virus (CDC)
This article has been updated
(See Five MERS Cases Reported in Riyadh, 03/14/14)

According to multiple reports, Saudi Health officials have announced another death from Middle East Respiratory Syndrome (MERS) in the Kingdom.

The 19 year old man was from al-Kharj, southeast of Riyadh. The report states that two of his sisters are suspected of having the virus and are hospitalized.

The Saudi Ministry of Health website reports 156 MERS cases in the country with 63 deaths.

Thursday, March 13, 2014

Three More MERS Cases in Saudi Arabia, UAE

MERS infographic
from Saudi MoH
The World Health Organization has been informed of three new cases of Middle East Respiratory Syndrome or MERS, two in Saudi Arabia and another in the United Arab Emirates (UAE).

The Saudi patients include two men from the Riyadh area. The first is a 51 year old man who suffers from chronic medical conditions and has had exposure to animals. He became ill on February 28 and was hospitalized on March 2.

The second Saudi patient is a 56 year old man who also suffers from underlying medical problems. He began to show symptoms on February 17 and was admitted to the hospital on February 25 where he passed away on March 3.

The case in the UAE involves a 68 year old man with chronic medical conditions from Abu Dhabi.  He reported no recent travel or contact with other MERS patients however, he owns a farm where he had frequent contact with animals, including camels.

He became ill on March 1 and was hospitalized on March 3. He is currently in stable condition.

WHO now reports 189 confirmed cases of MERS worldwide and 82 deaths.

 The UAE has reported 14 infections with the virus, with 5 deaths. 

The Saudi Minister of Health website reports 151 cases in the Kingdom, including 62 fatalities. It is unclear if the two additional cases reported today are included in that number.

Tuesday, March 11, 2014

WHO Confirms 186 MERS Cases; 81 Deaths

MERS virus (from CDC)
The World Health Organization (WHO) confirmed two recent cases of Middle East Respiratory Syndrome (MERS) in Saudi Arabia today. The pair of infections was announced by the Saudi government on February 20.

The laboratory confirmation concerned a 58 year old year old man from Al-Ahsa who suffered from chronic medical conditions. He became ill on February 2 and admitted to the hospital on February 4. He subsequently recovered and was discharged on February 24. He is reported to have had contact with animals.

MERS was also confirmed in the death of an 81 year old Riyadh woman was admitted to the hospital on February 2 and developed symptoms of the virus on February 5. She passed away three days later. She had reported no contact with animals before her illness.

These latest cases bring the total of laboratory confirmed MERS cases recognized by WHO to 186, including 81 deaths. Saudi Arabia has suffered the most MERS infections, accounting for 151 of the cases and 62 fatalities, according to the Saudi Ministry of Health website.

Thursday, March 6, 2014

Saudi MERS Cases Reach 150; 62 Deaths

From the Saudi Ministry of Health website
March 5, 2014 - MERS Totals in KSA
In a brief statement, the Saudi Ministry of Health announced two more MERS infections in Riyadh, one fatal.

A 55 year old man has passed away and a 51 year old man is in the Intensive Care Unit. Both men were suffering from chronic medical conditions.

No other information was released. The Saudi Ministry of Health's website now lists 150 MERS cases in the KSA, with 62 deaths.

At the last update, WHO recognized 184 confirmed MERS cases worldwide with 80 deaths. A report by the ECDC on February 23 put the total MERS cases at 186 with 87 fatalities.

Saturday, March 1, 2014

Egyptian Woman Tests Negative for MERS

Egypt's First Deputy Minister of Health for Preventive Science, Dr. Amr Kandil, said today that a woman from Aswan who had reportedly died of MERS has tested negative for the virus.

He had characterized the February 28 report as "just a case of suspicion" and said samples had been sent for testing.

A previous suspected case of MERS in Egypt in October, 2013 was found to be H1N1.

Suspicions that the woman had contracted MERS were raised when she became ill while performing Umrah pilgrimage in Saudi Arabia.

The woman, aged 56 years, was diagnosed with pneumonia in a hospital in Medina. She returned home to Egypt where she was admitted to Assiut University Hospital where she passed away.

Dr. Kandil stressed that Egypt is free of MERS so far.

Friday, February 28, 2014

MERS Death Reported in Egypt; WHO Issues Update

Umrah pilgrim may be Egypt's first MERS death
UPDATE February 28:
Dr. Amr Kandil, Undersecretary of Egypt's Ministry of Health stated that a woman who passed away on February 28 in Aswan has not been confirmed as having MERS.

He called the report 'just a case of suspicion' and said samples were being sent to the central laboratories for testing.

The report said the woman was 56 years old and traveled to Saudi Arabia for Umrah two weeks ago. She is reported to have visited a hospital in Medina where she was diagnosed with pneumonia. Upon returning to Egypt, she was admitted to Assiut University Hospital where she died upon arrival.

An Egyptian woman has died from the Middle East Respiratory Syndrome (MERS), according to this report.

The woman was from Aswan in Upper Egypt and had recently returned from Saudi Arabia after performing the Umrah pilgrimage. She became ill and was taken to a local hospital where she passed away on February 28.

MERS has been confirmed in eleven countries so far, most in the Arabian Peninsula. The cases which have occurred outside the region have all had direct links to one of the effected countries.

MERS was suspected in the death of a woman from Mansoura, Egypt last October but tests later proved she died of the H1N1 virus.

A February 28 update by The World Health Organization (WHO) has confirmed two previously reported MERS cases in Saudi Arabia.  One was a 22 year old from the Eastern Region who passed away on February 12 and the other was a 67 year old who was hospitalized on January 25.

Both men suffered from underlying medical conditions and are considered 'sporadic' cases. That is, they reported no contact with animals or other confirmed MERS patients.

WHO currently recognizes 184 confirmed MERS cases and 80 deaths. A report released by the ECDC on February 23 reported 186 cases of MERS with 87 deaths.

Monday, February 24, 2014

MERS Case Definition and Confirmation Standards

When an ill person arrives at a hospital emergency room, how does staff determine if the patient could be carrying a dangerous new disease, like the Middle East Respiratory Syndrome (MERS), rather than a common form of influenza?

Public health agencies use 'Case Definitions' to establish a uniform set of criteria which can be applied consistently across international boundaries and in a variety of health care settings. These commonly applied standards allow public health agencies to reliably count and classify suspected cases.

The Center for Disease Control and Prevention (CDC) and The World Health Organization (WHO) have issued guidelines for the identification and reporting of suspected MERS infections. A suspected case or, 'Patient Under Investigation' (PIU) would include:
  • A fever of 38°C/100.4°F or higher with pneumonia or severe respiratory distress
    plus one of the following risk factors:
  • Residence or travel to the Arabian Peninsula or neighboring countries within 14 days before the onset of symptoms or close contact with someone who has recently traveled there.
  • Members of a suspected cluster of patients with severe and acute respiratory illness of unknown origin, especially for clusters involving health care providers. These patients should be evaluated for MERS and state or local health departments should be consulted. 
Testing for a variety of respiratory illnesses can be conducted simultaneously and positive results for a different illness should not preclude also testing for MERS.

Countries which are at risk for exposure to MERS include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, UAE and Yemen.

A Close Contact is defined by the CDC as a family member, health professional or anyone else who cared or worked closely with a suspected or confirmed MERS patient. It also includes other household members or visitors while the patient was sick.

WHO considers a wider group to be close contacts, including individuals who work together, students attending the same classroom or persons traveling together in any type of vehicle.

Detailed guidelines from WHO for investigating suspected MERS cases, including a patient questionnaire, testing procedures, infection control and reporting information is available here (pdf).

Laboratory Confirmation vs. Probable Cases
Polymerase Chain Reaction (PCR) and sequencing are used to genetically verify the presence of the MERS corona virus and produce a laboratory confirmation of the disease

These techniques allow small fragments of DNA to be replicated thousands of times, enabling researchers to target and study specific regions of the gene. PCR replicates both strands of DNA whereas Sanger sequencing duplicates only one.

This technique is extremely sensitive and highly useful in identifying the virus, but samples can be easily cross-contaminated with a minuscule amount of foreign material or the wrong DNA fragment may be amplified. Therefore, two positive tests are required for confirmation.

Laboratory Confirmation of MERS requires genetic testing of the virus and must produce two positive targets, either through a positive PCR on a minimum of two specific genomic targets or a single positive target with sequencing on a second.

Asymptomatic cases are held to a higher standard of proof and should be verified by re-extracting the RNA and testing for different target genes and, if possible, at an independent lab.

Probable cases of MERS are also defined by a specific set of factors, involving clinical, epidemiological and laboratory criteria. The probable MERS patient will fit one of the following scenarios:
  • A patient with symptoms of pneumonia or acute respiratory distress with a direct epidemiological link to a confirmed MERS patient. MERS testing must be unavailable or produces a negative result when using a single and inadequate sample.
  • A patient with symptoms of pneumonia or acute respiratory distress who is a resident or visitor to a region where the disease is known to be present. In addition, there must have been an inconclusive laboratory test, such as a positive initial screening without confirmation.
  • Finally, a patient with respiratory illness of any severity who also is a close contact of a confirmed MERS case, combined with an inconclusive laboratory test, such as a positive initial screening without confirmation. 
WHO recommends re-testing inconclusive patients to definitively determine if MERS is present.

Public Health Agencies have developed a detailed Case Definition for identifying and reporting suspected MERS cases. These standards, though imperfect, provide researchers and health professionals with a set of common standards for reliably identifying and tracking the disease through a wide variety of health care facilities around the world.

Sunday, February 23, 2014

ECDC Issues MERS Update: 186 Cases; 87 Deaths

The European Centre for Disease Prevention and Control has released an update on the MERS virus in it's February 22 Communicable Disease Threats Report.

The report breaks down the numbers of MERS cases confirmed since April, 2012 by country and mortality:

MERS regional map

MERS has been confirmed in five countries outside the Middle East, accounting for twelve confirmed infections and six deaths. All of these victims had some link to the region, either through recent travel to one of the effected countries or had been in close contact with a confirmed or probable case.

MERS cases / deaths by country
Twenty-two cases in Saudi Arabia and three in the United Arab Emirates are considered asymptomatic, or without symptoms.

Although the virus can be spread through close contact or in health care facilities, as in a hospital cluster in Al-Ahsa, Saudi Arabia, researchers concluded it was not capable of sustained human to human transmission.

Detail of non-Saudi states
In order to better understand risk factors and epidemiology, the authors recommend, "investigative studies, including international case-control, serological, environmental, and animal-human interface studies."

The report emphasized the need for, "further review and strengthening of tools, such as standardised case definitions and surveillance, and further emphasis on infection control and prevention."

Since April, 2012, the ECDC has reported 186 laboratory confirmed cases of MERS, including 87 deaths.

Thursday, February 20, 2014

Saudi MERS Totals Rise; Researchers Call for Transparency

Cough and Sneeze Etiquette (from Saudi MOH)
In a brief statement, the Ministry of Health reported two new cases of MERS in the Saudi Kingdom today.

A 58 year old man from Al-Ahsa, who suffers from underlying medical conditions, is currently 'receiving the proper treatment', according to the announcement.

An 81 year old woman has passed away in Riyadh from MERS. She also suffered from chronic medical conditions.

No other details about these cases, including travel history or exposure to other MERS patients or animals, was released. Scarcity of information continues to frustrate researchers, who have yet to identify the source of the virus or method of transmission.

According to this study by the Annals of Internal Medicine, published January 27, 2014:
"The severity of symptoms, high fatality rate, and ease of transmission resemble the infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV) but data on MERS-CoV-infected critically ill patients are limited."
The scientific community's need for reliable and timely information is frustrated by a Saudi legal and cultural emphasis on personal privacy.

The custom of protecting personal information is fundamental and permeates the culture. It is based on a local interpretation of Sharia (Islamic) Law and is codified in the Saudi Constitution. Legal action can be taken against someone who wrongfully discloses another's personal data.

Despite the tension between local law and scientific need, the study concludes:
"The authors suggest an urgent collaborative study to examine therapeutic options to treat MERS-CoV, as the disease has the potential to become a worldwide public health threat. The authors of an accompanying editorial cite lessons learned from SARS-CoV and agree that scientific transparency and collaboration is needed to effectively protect populations from MERS-CoV."
CIDRAP reports there have been 186 cases of MERS worldwide with 81 deaths to date. The Saudi Ministry of Health website officially recognizes 147 MERS cases in KSA, including 61 fatalities.

Sunday, February 16, 2014

Saudi Man Dies of MERS; Two Test Negative in Hong Kong

KSA reports 145 MERS cases and 60 deaths
The Saudi Minister of Health has reported the death of a 22 year old man from the Middle East Respiratory Syndrome (MERS). The young man, who was from the 'eastern region' of the country reportedly suffered from cancer.

No other information was released regarding contact with suspected cases or exposure to animals. The Health Ministry website currently reports 145 cases in the Kingdom, including 60 fatalities.

A World Health Organization report issued on February 7 recognized 182 laboratory confirmed cases of MERS worldwide with 79 deaths since September, 2012.

Two Test Negative for MERS in Hong Kong
The Hong Kong Minister of Health reports two suspected cases of MERS have tested negative in preliminary tests for the virus.

The first involved a 20 year old man who had traveled with his wife to Guangzhou (formally Canton) in China and then Dubai, UAE on February 3. He became ill with cough and fever on February 7 and was admitted to Tuen Mun Hospital on February 12. He did not have contact with poultry or other confirmed MERS patients during his visit. It is unknown if he had contact with other types of animals.

The man is isolated and in stable condition. His mother and brother, who were also sick with a respiratory illness, have recovered.

The second case involves a 73 year old man who has been in isolation at Princess Margaret Hospital since February 11 and had become ill while traveling in Iran.

Hong Kong Department of Health Officials reassured the public that  "No human infection with this virus has been identified so far in Hong Kong,"

image from