Mild UAE HCW MERS Cluster Raises Pandemic Concerns
July 18, 2013
In the UAE, the four cases are health care workers from two hospitals in Abu Dhabi who took care of an earlier laboratory-confirmed patient. Of these, two cases, a 28-year-old man and 30-year-old woman, did not develop symptoms of illness. The other two cases, both women of 30 and 40 years old, had mild upper respiratory symptoms and are in stable condition.
The above comments from the latest WHO MERS coronavirus update describe two more hospitals involved in onward MERS-CoV transmission. The index case (82M) was the first case identified by the United Arab Emirates, and the above cases bring the total number identified by the UAE (see map) to 5, which is in addition to the case (65M) exported to France or the case (73M) treated in Germany.
The above four confirmed cases in health care workers (HCWs) follows a report of two mild Asir cases in the Kingdom of Saudi Arabia (KSA) described yesterday and confirmed by WHO today. That cluster was in Asir and also involved a HCW, which extends a trend in onward transmission throughout KSA involving mild cases (family contacts and/or HCWs). These milder cases have a case fatality rate of zero, because many are not hospitalized, while others are briefly hospitalized until, they test negative for MERS-CoV. These cases do not develop pneumonia and are not treated.
These mild cases were initially noted by KSA officials who commented in the spring that MERS-CoV was producing flu like symptoms in cases that did not require hospitalization of treatment. Since these officials noted that most of the mild cases were in Jeddah, when no mild cases had been confirmed, the comments strongly suggested that KSA was identifying and monitoring these cases using lab results that fell shy of the WHO definition of a confirmed case. Although it was unclear if these cases were just below the official cut-off, or were not confirmed in subsequent test due to sample degradation, or more stringent testing requirements, It was clear that the cases were being lab confirmed because mild cases would share symptoms with a wide variety of respiratory infections (and these cases were not “seemingly sporadic”).