MERS SARS-CoV-like Outbreaks In Al Hasa Hospitals…”the case fatality rate is 82% in KSA.”…(This Is Now A Level IV Bug!!!)
June 20, 2013
The above transmission map is Figure 2 from the New England Journal of Medicine paper “Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus” which details the MERS-CoV spread in Al Hasa (see map) in the Kingdom of Saudi Arabia (KSA). This large outbreak has striking similarities with SARS-CoV nosocomial outbreaks in 2003 which involve super spreaders and multiple transmission chains, which are readily seen in the above figure. Dispalyed are 23 confirmed cases, as well as two probable cases (the index case represented by dotted circle A and the super spreader represented by dotted circle C). The index case infected one of his sons (box O) and was the likely source for a health care worker (hexagon R) and the super spreader.
The super spreader infected 6 patients (circles D-I) in the dialysis unit, as well as one (J) in the ICU. Three of those infected by the super spreader were the source for two more rounds of transmission. Thus, there were three sets of H2H2H2H2H transmission chains and sequences were published from isolates from four members of these chains (patient K, A/Al Hasa 4/2013, infected doctor V, A/Al Hasa 1/2013 and both sequences were identical, while sequences from patient J, A/Al Hasa 2/2013, and patient I, A/Al Hasa 3/2013 were virtually identical).
The paper clear demonstrates multiple transmission rounds, but only describes a subset of the cases. There were 11 probable cases which were not detailed (other than the index case and super spreader) and are not included in the KSA MoH or WHO tallies. The index case was part of a 4 member family cluster, as described in multiple media reports and videos, as well as a detailed English language report, which was also carried on ProMED. The index case (56M, Mohammed al-Sheikh) was not tested, but his older son (33M) was confirmed. Another son (26M) was hospitalized and both brothers were pictured in media and video reports, including stories and videos on their discharges. A younger sister was symptomatic but tested negative and was not hospitalized. Thus, out of the four likely cases, only one was confirmed and listed in the KSA / WHO total.