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Saudi Arabia reports 4 more MERS cases, 2 fatal

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Translated information and media reports from Saudi Arabia today cited four more Middle East respiratory syndrome coronavirus (MERS-CoV) cases there, two of which were fatal.

In addition, the World Health Organization (WHO) announced that an earlier fatal MERS case in an elderly Tunisian man, previously regarded as probable, has finally been confirmed. The WHO also acknowledged a fatal case that was reported 3 days ago in Qatar.

According to an Agence France-Presse (AFP) report, the two fatal cases in Saudi Arabia involve two women: a 41-year-old expatriate healthcare worker in Riyadh and a 79-year-old Saudi who had chronic illnesses. The older woman had contact with another MERS patient in the northeastern city of Hafr Al-Batin, the story said.

The other two cases involve a 30-year-old Riyadh healthcare worker and a 47-year-old Hafr Al-Batin resident, both of whom are in hospital intensive care units, according to translated information from the Saudi Ministry of Health (MOH). The translation was posted by Australian virologist Ian Mackay on his "Virology Down Under" blog.

Mackay said the MOH provided no information on the patients' gender or when they got sick. His post described the 79-year-old as a construction worker.

Meanwhile, the WHO said the US Centers for Disease Control and Prevention (CDC) has confirmed MERS-CoV in the 66-year-old Tunisian man who died of his illness on May 10. His case was previously listed as probable, while the virus was confirmed in his daughter and son, who recovered.

The WHO gave no information on how the case was confirmed or why confirmation was delayed, and details were not immediately available from the CDC today. The man fell ill after a trip to Saudi Arabia and Qatar, according to earlier reports.

The WHO also recognized the fatal MERS case in a 56-year-old Qatari woman, as reported by the media on Sep 3. She became ill on Aug 18 and died Aug 31, the agency said. Her case was confirmed by Public Health England.

With the Tunisian and Qatari cases, the WHO raised its MERS count to 110 cases with 52 deaths. The agency has not yet noted the four cases reported in Saudi Arabia today.

The Saudi MOH has increased its own online MERS count to 88 cases with 44 deaths, from 84 cases and 42 deaths, though it had not yet posted an English-language statement about the new cases at this writing.

Saudi Arabia reports 4 more MERS cases, 2 fatal | CIDRAP
 
How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.


Should people avoid contact with animals or animal products?

Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided, and basic hygiene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between co-workers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.
 
How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.


Should people avoid contact with animals or animal products?

Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided, and basic hygiene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between co-workers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.

There was no registered cases to the virus being infectious through personal contact , at least not here in KSA form what I know.

Can you please post the page numbers too. I was trying to find what you have posted above in that pdf file but I couldn't. Not sure if my eyes are helping right now.
 

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