MERS-CoV Cluster: Three Generations in One Family Infected with MERS-CoV, Hafar Al-Batin, Saudi Arabia

Middle East Respiratory Coronavirus (MERS-CoV) is reported to have infected a family cluster of three generations in Hafar Al-Batin in the Kingdom of Saudi Arabia (KSA) (see map below). Hafar Al-Batin is a city in the Eastern Province (ash-Sharqīyah) of KSA with a population of almost 400,000 people.[1] Official information from the KSA Ministry of Health is lacking on this cluster, however, scattered Arabic language media reports from the region allow a tentative reconstruction of this cluster of at least 4 cases. Other MERS-CoV cases are reported from Hafar Al-Batin, including a health care worker. Some of these other cases may be associated with this cluster.  Each of the cases in the cluster is described below. 

A. 60-70?, F died (within the past few days), newly reported, not confirmed by World Health Organization (WHO). [2] 

B. Fahad Al-Sahli, 38, M  died (Aug 17 or 18, 2013), son of Case A.   Confirmed by WHO.  [3]
 

C. 7 (8?), F reported recovered, granddaughter of Case A, may be daughter or niece of Case B. Confirmed by WHO. [3]

D. 16, M reported recovered,  grandson of Case A and may be son or nephew of Case B. Confirmed by WHO. [3]
 

No information is available for the onset dates, hospitalization dates, the physical residence of each of the individual, or contact details.   It is extremely unlikely that all of these family members were infected from an unidentified animal host.  It is much more likely this cluster is a result of human-to-human transmission than exposure to a common animal reservoir.

[1] Hafar Al-Batin

[2] Saudi Arabia - 3 relatives of man who died of nCoV coronavirus are suspected cases - at least 2 hospitalized with no diagnosis to date

[3]  Middle East respiratory syndrome coronavirus (MERS-CoV) - update