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MERS Super Spreader In Eastern Region KSA Timeline
Recombinomics Commentary 18:00
November 2, 2013

Official information on this currently reported outbreak in Jubail is difficult to find. ProMED-mail would greatly appreciate more information from official sources on the validity of these media reports on the transmission of MERS-CoV in Jubail.

The above ProMED RFI highlights the dearth of official information on the nosocomial MERS outbreak in Jubail at the Royal Commission Hospital (RCH) – see map.  Moreover the index case (54M) for that outbreak may be linked to additional confirmed cases in Riyadh and the Eastern Region.

The cases in Jubail have been widely reported in local media, which have linked some of the confirmed cases to three deaths (54M, 83F, 54F) at RCH, including the index case.  The index case was reported by the Kingdom of Saudi Arabia on October 18 and was included in the batch of cases reported by WHO on October 24.  However, neither agency reported his death on October 22, which was widely reported in local media for the past two weeks.

The KSA-MoH reported noted that the case had traveled from Riyadh to the Eastern Region, but local media provided much more detail, indicating he was symptomatic while in Riyadh and traveled to Al Kobar, prior to his admission at RCH in Jubail.  He visited clinics at both locations.  He was admitted to RCH on October 17, so the confirmation made by KSA-MoH on October 18 was likely from a sample collected in Riyadh or Al Kobar.

KSA-MoH reported a confirmed Riyadh case (73M) on October 18, raising the possibility that the above index case for RCH was also linked to the Riyadh case. KSA-MoH also reported three confirmed cases on October 26 (83F, 56M, 49M) in the Eastern Region.  Media reports indicated two of these cases were in Jubail.  However, the absence of the 49M case from the Jubail media reports raises the possibility that the 49M case is linked to the index case via an Al Kobar clinic visit.  Similarly, the health care worker (56M) may have been transferred to Jubail and also infected by the index case prior to his October 17 admission to RCH.

However, the index case is linked to the 83F, who had been admitted to RCH a month prior to her death (which was reported by the KSA-MoH on October 27) and developed symptoms just after the index case died.
Similarly, the death of another case (56F), which was reported by KSA-MoH on October 31, also had been admitted to RCH well in advance of symptoms (12 days) which also began shortly after the death of the index case.  Media reports indicate the family of this case is considering suing RCH for negligence.

In addition to the above fove confirmed MERS cases, media reports cite 3 symptomaic cases in the RCH ICU.  One (15F) does not match the age of any of the confirmed cases, which the other two (in the sixth decade of life) which match one or both of the confirmed cases.

Thus, the index case may be a super spreader linked to one confirmed case in Riyadh and four confirmed cases in the Eastern Region as well as multiple suspect cases in RCH.

Therefore, more information on the cases in RCH, as well as contacts with the additional recent confirmed cases would be useful.

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