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Media Myth On Jeddah MERS Case Definition Change
Recombinomics Commentary 08:30
May 7, 2014

C.D.: You cannot compare the new numbers to those from a few months ago. Until the 26th of March, 459 tests had been done in all of Saudi Arabia this year. Then in just 1 month, just in the city of Jeddah, 4629 PCR tests were done. Something dramatic changed, and that is the case definition.

Before, tests were done on patients who had pneumonia and required [intensive care]. But now people are being tested not because they are sick, but because they had contact with a patient. Some of these tested positive, but many of them don’t really get sick.

The other three cases are female health care workers aged 29, 39 and 45 from Taif governorate who cared for two previously confirmed MERS-CoV cases and were detected as part of the outbreak investigation and contact tracing. Two of these three cases were asymptomatic and all three tested weakly positive by PCR.

The above comments (in red) suggest that the explosion of MERS cases in Jeddah is due to increased testing because the case definition recently changed, which is demonstrably false.  KSA began aggressively testing contacts almost a year ago after mild cases were identified in the 2012 Jordan outbreak by testing stored serum samples for antibodies.  In addition contacts of exported cases were PCR even though they had mild symptoms.

The above comments (in blue) are from a June 22 WHO update, reporting PCR confirmation in mild and asymptomatic contacts (family member and health care workers).  As noted in the commentary, this more aggressive testing of contacts would lead to more cases and a lower case fatality rate (CFR). 

KSA cited the lower CFR for Jeddah in its initial update, but more recent cases reported after the change in Health Minister showed that there are many severe and fatal cases, which are not due increased testing.  The increased testing was driven by the explosion of MERS cases, which was also associated with six recent exports of MERS from Jeddah.

Concern regarding the spread of the novel Jeddah sub-clade to Mecca remains.  The three sequences from Jeddah and Mecca, as well as the 25 spike gene sequences should be released immediately, no propaganda required.

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