Increasing Number of MERS-CoV Cases in the Jeddah Outbreak

As of  April 15, the total number of MERS-CoV cases associated with the outbreak in Jeddah, Saudi Arabia was at least 30 individuals.  See:

Current Status of the MERS-CoV Outbreak in Jeddah, Saudi Arabia 

The count of MERS cases in the Jeddah outbreak is now at least 47 individuals, including one pilgrim from Malaysia (link) who died. A media report indicates that two other traveling companions from Malaysia are now exhibiting symptoms as well (link). Whether these two other individuals were infected from a common source in Jeddah or a result of human-to-human transmission remains to be reported.

Current Status of the MERS-CoV Outbreak in Jeddah, Saudi Arabia

Since the middle of March, 2014, more than 30 individuals have been infected with MERS-CoV in the city of Jeddah in Eastern Saudi Arabia as reported by the Kingdom of Saudi Arabia (KSA) Ministry of Health.  Almost half of these cases have been officially reported in the past five days.

The official information provided by KSA on these cases is inconsistent. Onset dates after March 28, 2014, have not been reported for any the remaining 25+ cases. With the exception, of a father-son family cluster, few details are provided about the nature of the relationship between cases. Of these cases, 17 are reported as healthcare workers suggesting that many of these cases are a result of nosocomial infection. Four or five of these healthcare workers are reported as asymptomatic. 

The cases range in age from 25 to 71 years old. The mean age is 40 years old and the median age is 33 years old.  The infected individuals in Jeddah are on the average younger than previously reported cases from Saudi Arabia. The median age for all MERS-CoV cases in Saudi Arabia is about 50 with a median age 53.  

As least five of the individuals in this outbreak in Jeddah have died, although most of  the cases are still being treated. With an overall case fatality rate approaching 40% for reported MERS-CoV cases, more deaths can be expected from this outbreak. 

With little information about onset dates and the relationship between cases is it difficult to determine whether this outbreak is continuing to grow. 

Additional links: 

Hospital clusters of MERS-CoV cases, Jeddah, Saudi Arabia (map)

Is a younger cohort being infected with MERS on the Arabian Pennisula?

Is a younger cohort being infected with MERS on the Arabian Pennisula?

 A distinctive feature of the MERS  (Middle East Respiratory Syndrome) outbreak is the fact that confirmed case-patients are dominated by elderly individuals. Through February 28, 2014, the average age of a MERS-infected individual in Saudi Arabia was 52.3 years old (n=157).  A recent media report, however, suggests that the average of infected individuals is decreasing in Saudi Arabia.

“A Health Ministry source, speaking to Asharq Al-Awsat on the condition of anonymity, said that the average age of those being infected by the [MERS]  virus is decreasing, adding that over the past four months the average age of those infected was between 35 and 40 years of age” (link)

 

The statement is at variance with the data published by the Saudi Ministry of Health, although the age of infected individuals has been decreasing. Since March 1, 2014 the average age of an infected patient has only decreased to 46.8 years (n=32).  This decrease in average age is significant because many of the reported younger cases are health care workers in Jeddah with hospital- or contact-acquired infections.  Rather than infection from an animal reservoir, many of these infections are a result of human-to-human transmission. Several of the cases in Jeddah are asymptomatic and were only identified by contact tracing.  

The report today (link) of six health care workers (1 died) infected with MERS in the Emirate of Abu Dhabi demonstrates the infective nature of this coronavirus in a health care or hospital setting. Importantly, the media report indicates that all six of these individuals from the United Arab Emirates were younger than 40 years old.  There is now growing evidence that younger people are susceptible to the MERS coronavirus, at least in the context of hospital settings.

Hospital clusters of MERS-CoV cases, Jeddah, Saudi Arabia (map)

Several outbreaks of MERS (Middle East Respiratory Syndrome) have been reported in hospitals in Jeddah, Saudi Arabia, during this past week. According to a computer translation of a current media report (link), as many as 21 locally confirmed MERS cases have been identified in Jeddah.  These cases include nine cases at  King Abdulaziz University Hospital, seven at King Fahd Hospital,  and five at King Fahad Armed Forces Hospital.  These outbreaks include both doctors and nurses.   In addition, the report suggest that the Jeddah National Guard hospital, King Abdulaziz Medical City,  will also process MERS cases if necessary. The map below depicts the locations of these four hospitals in the Jeddah area.

The source of  the MERS coronavirus have been reported to be camels for some human cases. The source of infection for the cases in Jeddah is unclear, but at least several health care workers have been infected and one died indicating that some of these cases are a result of hospital acquired infections.   This current outbreak in Jeddah, the hospital outbreaks in 2013 in Al Hofuf in Eastern Saudi Arabia, (link) and the initial suspected hospital cluster in Jordan in 2012 (link) demonstrate that  the MERS coronavirus can be transmitted easily from human to human in hospital settings.