MERS coronavirus case reported in Saudi Arabia
Early last month, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) notified the World Health Organization (WHO) of one case of Middle East respiratory syndrome coronavirus (MERS-CoV).
Since the beginning of the year, a total of five cases including four deaths have been reported from KSA, and this is the first case reported since May 2024.
More specifics on the case:
The patient is a man aged between 50-55 years residing in the Eastern Region of KSA, developed a fever, cough, shortness of breath, and palpitations on 28 August 2024. He was admitted as a cardiac case to a local hospital on 31 August and transferred to a medical complex on 1 September. From there he was discharged at his request the same day, against medical advice.
He is a non-health worker with several co-morbidities. Following field investigation, there was no evidence of interaction with camels.
A nasopharyngeal swab taken on 1 September and tested at the National Public Health Laboratory as part of severe acute respiratory illness (SARI) sentinel surveillance, returned a positive result for MERS-CoV on 4 September through Real-Time Polymerase Chain Reaction (RT-PCR).
After the patient was discharged from the hospital and prior to receiving the laboratory results confirming MERS-CoV, he traveled to Pakistan on 2 September.
In KSA, follow-up has been completed for one household member, 23 health workers, and two patients who had contact with the case, with no secondary cases reported.
Among close contacts listed in KSA, one travelled from Saudi Arabia to South Asia on 4 September. Flight details and personal information were retrieved to initiate contact tracing and follow-up, and no secondary cases have been identified in connection with this high-risk contact.
Following the notification on 5 September 2024 from the International Health Regulations (IHR) National Focal Point (NFP) of KSA to the Pakistan IHR NFP regarding the patient’s travel and positive MERS-CoV results, the patient was located in Pakistan, and the health authorities proceeded to transfer the patient to a public hospital for strict isolation and management of existing comorbidities.
A total of 41 nasopharyngeal samples, including repeat samples of the case and close contacts were collected and tested at the Pakistan National Institute for Health/National Reference Laboratory. The patient tested positive, albeit with a low viral load, while all contacts tested negative. Close contacts, including family members and health workers, were closely monitored for 14 days, and no secondary cases have been identified.
The patient was discharged on 13 September after receiving a negative test result for MERS-CoV, along with instructions to continue oral medication and to return for a follow-up appointment in five days. This follow-up was successfully completed on 19 September, confirming the patient's full recovery.
The new case reported is believed to have acquired MERS-CoV infection locally within KSA. However, the potential for international transmission is increased due to the fact that the individual visited Pakistan, while a high-risk contact traveled to South Asia within the 14-day follow-up period. Both individuals had arranged their travels prior to the occurrence of the event and before the test results of the case were obtained and disseminated.
Since the first report of MERS-CoV in the KSA in 2012 until now, human infections have been reported in 27 countries— Algeria, Austria, Bahrain, China, Egypt, France, Germany, Greece, Islamic Republic of Iran, Italy, Jordan, Kuwait, Lebanon, Malaysia, the Netherlands, Oman, Philippines, Qatar, Republic of Korea, Kingdom of Saudi Arabia, Thailand, Tunisia, Türkiye, United Arab Emirates, United Kingdom, United States of America, and Yemen.
Since the first report of MERS-CoV case in KSA in 2012, a total of 2205 human cases and 860 deaths have been reported. Overall, a total of 2614 MERS-CoV cases and 941 deaths have been reported globally.
Approximately 35% of cases reported to WHO have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems.