Wednesday, 11 September 2013

MERS mounts up...

In a strange coincidence of numerals, the 4th Middle East respiratory syndrome coronavirus (MERS-CoV) report in a row from the Ministry of Health (MOH) of the Kingdom of Saudi Arabia (KSA) contains very little on 4 cases

I use below, the FluTracker's (FT) case numbering scheme because frankly, they produce the only numbering schemes for tracking cases of new or returning infectious disease that are systematic, reliable and worthy of our trust


It should form the basis for a worldwide numbering system for infectious disease outbreaks because it is also freely and publicly available such that any potential manuscript author can easily check it before submitting a research paper and then we could all know which case is being discussed. And by "we" I mean fellow researchers, not just interested parties. 


The KSA MOH could consider running their own table of data akin to that of FluTrackers, but augmented and using an adapted version of Crawford Kilian's wishlist to the MOH. Each (deidentified) case entry should include the following headings along the top row, filled out if and as they become relevant:

  1. A unique, continuous identifying code specific to this emerging virus
  2. Sex
  3. Age
  4. Occupation
  5. Co-morbidities
  6. Date of illness onset
  7. Town of illness onset
  8. Town of acquisition
  9. Date of hospitalisation
  10. Type of laboratory testing
  11. Date of laboratory confirmation
  12. Date of death
  13. Date of release from hospital
  14. Treatments/management
  15. Town of treatment
  16. Relationships to any other cases
Today's MERS-CoV cases are mostly asymptomatic. These cases are announced amid rumours of larger case numbers being tested, panic in hospitals over potential MERS cases, frustration from within KSA over the MOH's poor performance, and of the KSA cracking down on healthcare workers who pass on rumours as well as prosecuting bloggers.

Today we have:

  1. FT#125: 22-year old asymptomatic male, citizen of Madinha (Medina), contact of another confirmed case (we shall call him Mr/Mrs/Ms/Dr X)
  2. FT#126: 24-year old asymptomatic male healthcare worker in Madinha
  3. FT#127: 60-year old asymptomatic male citizen of Riyadh, contact of another case (also unknown)
  4. FT#128: 47-year old male citizen of Riyadh, contact of another unknown case, symptomatic but stable
This brings the tally to 128 with 57 deaths (proportion of fatal cases, PFC, at 45%). Where data for sex exists, males comprise 63% of cases and 74% of deaths in people confirmed as positive for MERS-CoV. 82% of cases come from the KSA and, if counting back to the retrospectively identified cases from Jordan, we take the first week of disease associated with MERS-CoV infection as that beginning 19-Mar-=2013, then we are in 78th week of MER.