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."