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Nosocomial MERS Cluster In Jubail KSA Grows
Recombinomics Commentary 23:00
October 31, 2013

the Ministry of Health (MOH) has announced that a new case of the virus passed away in the Eastern Region.

The case was for a 56-year-old female citizen, who was in contact with a confirmed case of the virus, and she had been suffering from various chronic diseases

The above comments from the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) website describe the fifth recently confirmed MERS case in the eastern region.  Media reports describe at least four cases (54M, 83F, 54M, 56F) in Jubal (see map), which includes at least three deaths (56M, 63F, 56F), including the index case (54M), who had been in Riyadh.  The delayed reporting of the fatal cases (one, 83F, reported a day prior to reporting her death, while the above case was reported after her death), as well as the absence of the death of the index case (which was widely reported in local media last week prior to the reporting of the four most recent cases) raises concerns that the number of cases linked to the hospital in Jubail is significantly higher than the five confirmed cases.

The nosocomial cluster in Jubail has much in common with the nosocomial cluster in Al Hasa.  The initial cases were reported after they died, and the location of the cluster was withheld.  Like the current cluster, cases were cited as coming from the eastern province, which has multiple population centers.

The Jubail cluster represents the first reported confirmed cases in and around that city, which like the Al Hasa cluster includes at least one health care worker.  The NEJM paper on the Al Hasa cluster cited two health care workers (including one case who subsequently died) which were among the 23 confirmed cases.  11 additional cases were defined as probable (hospitalized for pneumonia with a link to at least one confirmed case, but were not lab confirmed because of an absence of testing, or testing limited to one sample).  The number of Al Hasa MERS infections was likely considerably higher than the 34 confirmed / probable cases, which is also true for the Jubail cluster.

More information on the relationship between confirmed cases as well as linkage to additional symptomatic cases in Jubail would be useful.

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