Thursday 7 November 2013

MERS-CoV case in Spain, imported from Saudi Arabia during visit for Hajj pilgrimage [UPDATED]

Spain's Ministry of Health, Social Services and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad) has been reported via the media (not yet on their website) as describing the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Click to enlarge.
MERS map of the world. Countries hosting internal
transmission for MERS-CoV are shown in red. Those
hosting imported cases in orange.
The case is being presumed to be imported from the Kingdom of Saudi Arabia (KSA). The subject, a 61-year old Moroccan woman (61F; presumably FluTracker's #153) living in Spain, had spent a month in the KSA (Oct 2 to Nov 1; the Hajj specifically occurred during Oct 13-18) and was showing signs and symptoms of a febrile cough illness on the 15th of October. She did attend the Hajj according to Helen Branswell's article. So can now put the "no cases during the Hajj" story to bed? We don't technically know when the virus was acquired.  61F was in the KSA for a long period so acquisition may have occurred before or after but let's not split hairs, it was a Hajj-related acquisition. 

61F is stable with a diagnosis of pneumonia (chest X-ray) which was made sometime around 28/29 October in a hospital in the KSA.

Timeliness is a big concern here. It seems that 7-days passed between a clinical diagnosis of pneumonia in KSA, a flight from Jeddah to Madrid and a laboratory diagnosis (at the National Center for Microbiology in Spain) of MERS-CoV infection on Nov 5th. That's perhaps 21-days between onset and laboratory confirmation. Spanish contact tracing commenced at the time of confirmation (6-Nov). 

I guess we'll see if there are any more details to be had about the transport process (isolation/containment procedures?). We do know that 61F was symptomatic and needed oxygen during the flight. 

It's a good thing MERS-CoV does not seem to transmit efficiently - there may have been many exposures between the 15th and the final diagnosis and hospitalisation in Spain. And why could the laboratory testing not have been completed in the KSA? Was a swab/aspirate/lavage taken for any testing there? Either this is a political thing or there are (?many) cases of pneumonia in the KSA that are going untested for MERS-CoV....or for any virus or bacterium?

The current MERS-CoV tally is 151 cases, 64 deaths (42.3%)

See Mike Coston's posts of the early reports here and here. Thanks to Helen Branswell (@HelanBranswell) for tweetification.

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