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MERS-CoV Geographic Spread Raises Ramandan Concerns
Recombinomics Commentary 23:45
June 16, 2013

The first citizen in the eastern region at the age of 42 years and receiving treatment in the hospital and suffers from chronic asthma, and the second case of a citizen in the area of Riyadh at the age of 63 years and is receiving treatment in intensive care and suffer from multiple chronic diseases. The third case is a child in Jeddah at the age of two years, and suffers from a chronic disease of the lungs and receiving treatment in intensive care. This brings the total number of confirmed cases of 49 cases.

It also announces four deaths of previously recorded cases, including two deaths in the province of Taif and two in the eastern region

The above comments are from the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) website on MERS-CoV cases.  The three new cases increase the number of confirmed cases to 49 and the four new fatalities increase the number of deaths to 32.  However, there have only been 7 cases discharged, so the case fatality rate (CFR) for cases with outcomes has increased to 82%

However, the new cases have significantly increased the spread of MERS-CoV within KSA. Previously, new cases were largely limited to two nosocomial outbreaks in the eastern region.  The KSA-MoH had offered assurance for pilgrims planning on performing Umrah during Ramadan, which begins July 9 because cases were in the eastern region and Mecca and Medina were in the west.

New cases unlinked to the two nosocomial outbreaks began to be announced earlier this week with a death in Hafar Al Batin which was in the eastern region, but over 200 miles northwest of the nosocomial outbreaks (see map).  That case was followed by three cases much closer to Mecca. One was significantly south of Riyadh, but within Riyadh province in central KSA, while two cases were in Taif just east of Mecca (see map).

As noted above, the two recent cases in Taif have now died, but now there is a case in Jeddah, which is just west of Mecca, as well as a case in Riyadh.

Media reports raise concerns that there are many additional hospitalized cases which have not yet been confirmed.  One report cited a dialysis patient in Riyadh, raising concerns of another nosocomial outbreak in Riyadh.  Another report cited additional suspect cases and at least one death in Riyadh province raising concerns that there is a nosocomial infection south of Riyadh.  Another media report cited 7 cases in Taif, including two health care workers (HCWs) raising concerns that there was a nosocomila outbreak ion Taif near Mecca.  Yet another media report cited the death of a cardiologist in Dhahran, in eastern KSA.
The reports of infections of HCWs in multiple locations associated with multiple nosocomial outbreaks have striking similarities with the spread of SARS-CoV in 2003.

Moreover, the dramatic spread of MERS raises serious concerns that the influx of pilgrims performing Unrah for Ramadan, which begins July 9 will lead to a dramatic spread of MERS-CoV worldwide.

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