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WHO Confusion On Spain MERS Hajj Cluster Raises Concerns
Recombinomics Commentary 16:00
November 19, 2013

The onset was on October 15, 2013
In fact, Mounts said it is possible that she contracted the virus after the pilgrimage was over, which would assuage fears that the event might seed MERS outbreaks in other countries too.

"The concern we had was that the Hajj would accelerate spread, that there would be transmission in the Hajj, during the Hajj itself," he said.

But if investigation of the woman's case leads to the conclusion she became infected after the pilgrimage, her participation in the Hajj will turn out to be coincidental. "And if that's the case, I think it's a little less concerning," Mounts said.

The above translation (in blue) is from the Spain Ministry of Health (MoH) alert issued on November 6, which also cited lab confirmation of the case (61F).  That report generated a large series of local reports which cited the above disease onset date.
However, an English language report, following the Spain MoH and local reports, detailed WHO speculation (in red above) on an onset after the Hajj (which was from October 13-18).  Since Mounts was the WHO point person, he should have been well aware of the disease onset, since the Spain MoH had already published the date, which they clearly knew well in advance of the October 6 alert.  Additional reports noted that the index case had traveled to Kingdom of Saudi Arabia (KSA) on October 1 and had been in Medina prior to developing symptoms in Mecca.  Mounts was also aware of the fact that she sought medical treatment in Mecca on October 28, so the basis for the speculation (and its publication) was far from clear.  His comments on the index case were more appropriate for the travel companion, who was not cited prior to the Spain MoH alert on October 14, which noted the MERS lab confirmation for the companion.

The delayed testing and confusing media reports is similar to the cluster in England in early 2013, which was also linked to a return from KSA (after performing Umrah in association with the medical condition of his son, who was undergoing treatment for a brain tumor.  The index case had traveled to KSA with a daughter, but her condition was not described in initial media reports.  The son and sister of the index case were subsequently MERS confirmed, and both cases were also co-infected with para-influenza type 2 (HPIV-2) in contrast to the index case who was co-infected with H1N1pdm09.  The daughter of the index case was tested after she recovered, and consequently tested negative.

The delay in testing contacts of the Spain cases raises similar concerns regarding MERS false negatives.

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