Saturday, 7 September 2013

Death of a young adult Qatari MERS patient who presented with flu-like illness...

So that last post is out of date already.

The Qatari Supreme Council of Health, as it does, has issued an announcement through the media (it has yet to update it's technically troubled website) announcing the death of the previously described 29-year old male with asthma who had been confirmed by an international (presumably UK-based) reference laboratory.

Asthma occurs in about 5% of the world's population, but in higher proportions in particular countries and regions.

This moves the deaths up to 54 with data, possibly 56 in total (see earlier post today for what that means) with a PFC of 48.3% for 56 deaths.

The presentation of this case on August 17th, was of "flu-like illness" which can be anything from fever + cough to much more. What this case highlights, and it is only a single case, is that cases can present with standard upper respiratory tract infection (flu most often starts off that way) which will make it devilishly hard to discriminate from that caused by many other non-MERS-CoV respiratory viruses. In a study of pilgrims leaving the 2012 hajj, 41% had flu-like symptoms (cough, sore throat and fever). I mentioned this in an earlier post (see #3 in the Prof Memish lit review) and the paper in Feb this year from Clinical Microbiology and Infection can be found behind a paywall here. A subsequent article published in Clinical Infectious Diseases this July, also paywalled and by the same group showed that a number of respiratory viruses were lab-confirmed as acquired while in the Kingdom of Saudi Arabia (showed symptoms of  illness), fewer were brought into the country and fewer were taken out. Not much can be concluded from that as I would expect this in any group tested in this way under these circumstances (travelling to a gathering of lots of people from around the world and from different climates  experiencing different respiratory virus seasons). It is not surprising that when you throw people together, they transmit respiratory infections and the the number of cases spikes.

This will be a big challenge if observation alone, rather than prospective laboratory testing, is used as a method to diagnose MERS among hajjis (thanks to AtRG for this phrase), in the coming weeks.