Jeddah MERS Export To Greece Raises Concerns

Monday, April 21, 2014
By Paul Martin

Recombinomics.com
April 20, 2014

The patient is a 69-year old male Greek citizen residing in Jeddah, Saudi Arabia, who travelled back to Greece on 17 April. While in Jeddah, the patient consulted a hospital on 8 and 10 April for a febrile illness with diarrhoea, and was given a probable diagnosis of typhoid fever. Of note, he regularly visited his wife who was hospitalised from 31 March to 5 April in the same hospital for a confirmed typhoid fever.

The patient sought medical care upon arrival in Greece on 17 April. The evaluation revealed a bilateral pneumonia and the diagnosis of MERS-CoV infection was made at the National Reference Laboratory for Influenza.

The above comments from the April 20 WHO update provide additional detail on the MERS export (69M) from Jeddah to Greece. The wife of the case was diagnosed as “confirmed typhoid fever”, which was also said to be probable for the latest case. However, testing in Greece identified MERS.

In the same time frame Jeddah exported MERS to Jordan and Malaysia, signaling widespread MERS in Jeddah. The KSA-MoH has reported 46 confirmed cases in Jeddah in 9 daily reports between April 10 -19, with incremental increases from 3 cases per day for April 10 & 11 to 6 or 7 cases per day for the past 4 days (3, 3, 4, -, 5, 5, 6, 7, 6, 7).

The failure of KSA to diagnose MERS in this case raises concerns that reports indicating cases were far higher than reported due to physicians reporting cases orally and not in charts, which have misdiagnoses to explain symptoms as well as fatal outcomes.

The absence of WHO reports on these Jeddah cases (the most recent WHO report on the above cases, April 14, cites the age and gender for the three cases reported by the KSA-MoH on April 10, but has no information on dates for disease onset or hospitalization, or any information the patient’s condition) increases concerns.

The delays in reporting the most recent 43 Jeddah cases also raises concerns that the KSA-MoH reports, which have no dates, are not reporting cases in a timely manner, are not IHR compliant.

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