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Commentary
Abu Dhabi MERS Superspreader Linked To 22
Confirmed
Recombinomics Commentary 14:00
April 23, 2014
All the cases are from Abu Dhabi and have had close contact with a laboratory-confirmed case reported on 10 April. To date, the cases are kept in isolation in a hospital and are well. Screening of other health care contacts and family members are ongoing.
A 52 year-old woman who had mild illness on 9 April and was screened on 10 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 28 year-old who was screened on 10 April. He has no illness and is reported not to have any underling medical condition and does not have exposure to animals or a recent travel history.
A 59 year-old man who was screened on 12 April. He has no illness. He is reported to have an underlying medical condition. He is reported not to have exposure to animals or a recent travel history.
A 28 year-old man who was screened on 10 April. He developed mild illness on 11 April. He is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 55 year-old woman who was screened on 12 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
A 28 year-old woman who was screened on 10 April. She developed mild illness on 8 April. She is reported to have no underlying medical condition and does not have exposure to animals or a recent travel history.
The following details were provided to WHO on 18 April by the Ministry of Health UAE:
A 63 year-old woman from Abu Dhabi who had close contact with a previously laboratory-confirmed case reported on 14 April. She was screened on 13 April and became ill on 15 April. She is reported to have an underlying medical condition. She is reported to have no exposure to animals or a recent travel history.
A 73 year-old woman from Abu Dhabi who has been an in-patient at the hospital since 26 February due to other illnesses. She has underlying medical conditions. The patient was admitted to the intensive care unit (ICU) on 14 April. She is reported to have no exposure to animals or a recent travel history.
The above comments are from today’s WHO update on MERS cases in the United Arab Emirates (UAE). The cases in red are health care workers (HCWs) directly linked to the 45M superspreader who had previously been linked to 14 HCWs, raising the number of confirmed cases directly linked to this case to 20.
The cases in blue represent onward transmission. One case (63M) is closely linked to one of the 14 HCWs, while the second case (73F) appears to be a nosocomial case at the same hospital.
Thus, the cluster of cases directly or indirectly linked to the superspreader is now 22. One of these contacts (34M) flew to the Philippines, where he was isolated and subsequently tested negative (his positive test was on a sample collected in the UAE, with results released after he had left).
In general, the contacts are asymptomatic or mild, and HAAD has reported that 10 have subsequently tested negative and have been discharged / released from the hospital. However, the large number of lab confirmed HWCs directly or indirectly linked to the same patient (superspreader), are similar to the data generated by SARS superspreaders in 2003.
Moreover, although one of the contacts traveled to the Philippines, there has been no onward transmission linked to him, which is likely due to the absence of symptoms. However, the WHO update does cite onward transmission in the Abu Dhabi hospital.
In contrast to the export of MERS from the UAE, which was not confirmed in the importing country, the have been 5 recent MERS exports from the Kingdom of Saudi Arabia (KSA) and all five were lab confirmed in the importing country (Jordan twice, Malaysia, Greece, and UAE). Moreover, four of the five were exported from Jeddah.
Export of MERS from one location (Jeddah) to four different countries, is similar to the international spread from the Metropole Hotel in Hong Kong to hospitals in Hong Kong, Singapore, Vietnam, and Canada. Although there has not been documented onward MERS transmission in these importing countries, three of the four cases had sought medical treatment in the KSA, and MERS was not diagnosed. In addition, two of the cases have died and a third is in critical condition, representing a high case fatality rate seen in superspreaders in 2003 (and the 45M superspreader in the UAE also died).
The documented superspreader in the UAE, and reported exports from Jeddah over a short time frame (all were reported in the past two weeks), raises serious concerns.
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