With Saudi Arabia reporting more than 80% of all Middle East
Respiratory Syndrome (MERS) cases to date, detailed information about the
individual cases from Saudi Arabia is critical to understanding the nature and
spread of this novel disease. There are some discrepancies among the MERS cases
reported by World Health Organization (WHO) from Saudi Arabia. Of course, WHO
is constrained by the quality of data provided by its various member states.
Generally, WHO provides detailed information on the initial
cases of a novel disease outbreak in its online publication,
Disease Outbreak News (DON). The first
WHO report of a MERS [novel coronavirus] infection was published on
September 23, 2012. Between
September 2012 and April 16, 2014, WHO reported details on 228 MERS cases with
varying levels of details provided by the reporting member states. Of the 228
cases reported by WHO though that date, 181 were individually reported cases
from Saudi Arabia. The
DON
of April 14, 2014 (15 reported cases from Jeddah and Riyadh) was the last Saudi
Arabian case-by-case report from WHO. After that date, WHO only provided
aggregate case totals from Saudi Arabia. These aggregate totals were embedded
in 6 DON reports between May 7, 2014 and June 13, 2014 as noted in the table
below.
On June 13, 2014, WHO provided a summary of these aggregated
cases. According to WHO, 402 cases were summarized. However, a tally of the WHO
totals from the previous DONs indicates that only 401 cases were actually
aggregated. A comparison of the WHO total with media reports from the Saudi
Arabia Ministry of Health indicates that 404 MERS cases were publicly reported
by the Ministry of Health.
For the period between April 11, 2014 and May 4, 2014, WHO
reports 229 cases from Saudi Arabia, although the
Saudi Arabia Ministry of Health only publicly
reported 228 cases during that period. One possible explanation is that the 51
one-year-old individual from Riyadh reported on April 9, 2014
by
the
Saudi Arabia Ministry of Health (
link
FluTrackers case # 227), not previously enumerated by WHO, was added to the
aggregate total (see:
link).
Also,
between May 5, 2014 and May 9,
2014 Saudi Arabia Ministry of Health reported 62 MERS cases. During this same period
WHO only reported 58 cases in aggregate (see:
link).
It is possible that WHO failed to incorporate four cases into its cumulative
tally for this 5-day period in Saudi Arabia.
With the reporting of specific case details of two
individuals from Saudi Arabia in
DON on June 16, 2014,
WHO has now apparently returned to
reporting individual case details from Saudi Arabia. Better individual case
details may again be flowing from Saudi Arabia to WHO.
Depending on the quality and accuracy of the data provided
by Saudi Arabia, a discrepancy of 3 or 4 cases among more than 500 reported cases
falls within a reasonable error factor. Such differences will not appreciably
affect interpretations or speculations drawn from such a large sample of cases.
Of more serious concern is a report on June 3, 2014
by the Saudi Arabia Ministry of Health indicating
retrospective reporting of more than 100 additional MERS cases in Saudi Arabia
(and acknowledged by WHO -
link) going back to
May 2013 (See:
The
Saudi Arabia Ministry of Health Quietly Announces an Additional 113 Cases of
MERS). This means that from May 2013 through April 2014, about 15% of all
MERS cases in Saudi Arabia were unreported. A 15% error factor is unacceptable
when public health officials and the rest of the world are trying to understand
the nature of a novel infectious disease with a high fatality rate.
