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Paradigm Shift Intervention Monitoring
Nosocomial Spread In Al Hofuf KSA
18 males, 7 females; Ages 14-94 years, median 58
Initial cases associated with one hospital but now also:
- Family contacts
- Health care workers
- Cases with no link to hospital
The above comments on the KSA Al Hasa outbreak (see map) are from slide 34 of the June 13 COCA conference call on MERS-CoV: Information and Guidance for Clinicians. The June 14 WHO update cites two more cases and another death including more cases from Al Hasa. The Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) has released four full sequences (Al Hasa 1/2013, Al Hasa 2/2013, Al Hasa 3/2013, Al Hasa 4/2013) from cases linked to the above cluster, which were from collections between April 21 and May 9. All four sequences were virtually identical (one or no difference with a consensus sequence larger than 30,000 BP) signaling clonal expansion within the hospital (nosocomial outbreak). This spread within the hospital over an extended time frame has similarities with the SARS-CoV hospital outbreaks in 2003. Moreover, the sequence similarities with Engalnd2/2013 signal human evolution and discounts the role of any animal reservoir in outbreaks in 2013.
Moreover, the outbreak in a hospital in Al Hofuf was followed by a similar outbreak in another eastern city (name of city and hospital withheld), raising concerns that the widespread infections in the community are leading to onward transmission in hospitals. The Al Hofuf outbreak may have been linked to contaminated dialysis equipment and a media report has raised the possibility that a dialysis patient in Riyadh may be MERS-CoV infected.
The recent cases in eastern, central, and western KSA signal widespread infections, which spread may be accelerated by pilgrims arriving in Mecca and Medina while performing Umrah in association with Ramadan, which begins on July 9.