Delayed Spain MERS Hajj Cluster Testing Raises Concerns

Tuesday, November 19, 2013
By Paul Martin
November 19, 2013

Study conducted close contacts have been obtained so far laboratory results 65% of these being negative.

Gregory Härtl ‏@HaertlG 8h
.@HelenBranswell @WHO 1 #Kuwait #MERS case had travel history to #KSA. Still waiting for #Spain confirmation.

The above translation (in red) is from the November 14 alert from the Spain Ministry of Health citing lab confirmation of a second MERS case (who traveled with the first MERS case, who developed symptoms on October 15). Thus, one month after the index case developed symptoms, WHO has not confirmed the index case (as indicated by today’s Gregory Hartl tweet , in blue) and more than 1/3 of her contacts has not generated a lab result.

These testing delays raise serious concerns. The index case was hospital tested for pneumonia and her x-ray was positive on October 28. She declined admission and flew back to Madrid from Jeddah on November 1. Breathing difficulties led to treatment with oxygen in flight, which would have exposed the flight crew, passengers, and contacts.

Thus, the number of contacts who traveled with the two lab confirmed cases, either as a group attending the Hajj or passengers exposed to the two confirmed cases would be high, but one month after the index case developed symptoms, test results on more than 1/3 of her contacts had not been generated.

Similarly, more than a month after she became symptomatic and more than two weeks after she returned to Spain, WHO has not confirmed the local lab confirmation announced by the Spain MoH on November 6.

These testing delays suggest that many infected contacts will be reported as negatives due to testing delays.

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