FW: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI

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Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI


MERS-COV - EASTERN MEDITERRANEAN (30): SAUDI ARABIA, UAE, WHO, REQUEST FOR INFORMATION
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>

In this update:
[1] Saudi Arabia, 5 new cases, 1 death - MOH 14 Apr 2014 [2] Saudi Arabia, 15 new cases (2 deaths), UAE 1 case (1 death) - WHO
14 Apr 2014
[3] UAE, colleagues of fatal case - media report 14 Apr 2014 [4] & [5] Need for transparency - media reports

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[1] Saudi Arabia, Jeddah, 5 new cases, 1 death - MOH 14 Apr 2014
Date: 14 Apr 2014
Source: Saudi MOH [in Arabic, machine translation, edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-14-001.aspx>


In the context of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the coronavirus causing Middle East respiratory syndrome (MERS CoV), the ministry announces the registration of 5 cases of HIV infection in Jeddah.

The 1st resident, a 70-year-old male, has passed away. The 2nd, a 51-year-old citizen, is receiving intensive care. The 3rd is a 28-year-old healthcare worker who is asymptomatic [there is a mention of "for citizenship," suggesting an expatriate who may have applied for citizenship]. The 4th is a 45-year-old female resident healthcare worker without symptoms, and the 5th is a 56-year-old male resident in stable condition.

During the last period [since 12 Apr 2014, when the last information was provided?], 190 samples have been tested, of which all but the aforementioned [5] were negative for infection with MERS-CoV.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[With the addition of these 5 newly confirmed cases, including one death, of MERS-CoV infection, this increases the total number of MERS-CoV infections reported by Saudi Arabia to 192 including 69 deaths, and if this moderator's count is correct, it brings the number of cases reported in Jeddah since 27 Mar 2014 to 28, including 4 deaths, 5 in intensive care, 6 in stable condition, and 13 reported as asymptomatic infections.

Of additional note is that 9 of these 28 reported cases (32 percent) in Jeddah were in healthcare workers (HCWs). One wonders what protocol is being followed in Saudi Arabia for respiratory precautions and what proportion of HCWs are following these protocols. Of curiosity is that in the 12 Apr 2014 Saudi MOH update announcing 4 new laboratory confirmed cases of MERS-CoV infection, the update in the Arabic language report mentions that 3 of the 4 cases were in HCWs, whereas the English language version only mentions 2, not mentioning the 26-year-old female as an HCW. Thanks to Helen Branswell for pointing this discrepancy out. Clarification from knowledgeable sources in the region would be greatly appreciated.

For a map of Saudi Arabia, see <http://healthmap.org/promed/p/131>. - Mod.MPP]

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[2] Saudi Arabia, 15 new cases (2 deaths), UAE 1 case (1 death) - WHO
14 Apr 2014
Date: 14 Apr 2014
Source: WHO Global Alert and Response [edited] <http://www.who.int/csr/don/2014_04_14_mers/en/>


WHO has been informed of an additional 16 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus
(MERS-CoV) from Saudi Arabia and the United Arab Emirates (UAE).

The 15 additional laboratory-confirmed cases, including 2 deaths announced on the Ministry of Health of Saudi Arabia website and provided to WHO between [6 and 11 Apr 2014] include:

- A 70-year-old man from Jeddah with underlying medical conditions. He became ill on [24 Mar 2014], was hospitalized on [29 Mar 2014] and died on [5 Apr 2014].
- A 28-year-old man from Jeddah with no reported symptom of illness.
The man is a household contact of the above mentioned laboratory-confirmed case.
Three health-care workers:
- a 26-year-old woman, a 26-year-old man, and a 33-year-old man with no symptoms of illness.
- A 28-year-old man who is a healthcare worker in Jeddah. He became ill on [28 Mar 2014], was admitted to a hospital on [3 Apr 2014], and is currently receiving treatment in an intensive care unit.
- A 35-year-old man from Jeddah with no reported symptom of illness.
- A 32-year-old woman from Jeddah who is a healthcare worker with no reported symptom of illness.
- A 45-year-old man from Riyadh. He became ill on [30 Mar 2014], was hospitalized on [5 Apr 2014], and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
- A 90-year-old man from Riyadh. He became ill on [30 Mar 2014], was hospitalized on [1 Apr 2014], and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
- A 57-year-old man from Riyadh with underlying medical conditions. He became ill on [16 Mar 2014], was admitted to a hospital on [19 Mar 2014], and died on [30 Mar 2014].
- Four men aged 29, 33, 34 and 70 years old from Jeddah.

Additionally, a previously laboratory-confirmed case has died. The concerned health authorities in Saudi Arabia are currently conducting investigations into the contacts of the cases.

The additional laboratory-confirmed case reported by the Ministry of Health of the UAE on [10 Apr 2014] includes:
- A 45-year-old man from Abu Dhabi who became ill on [6 Apr 2014], was hospitalized on [7 Apr 2014] and died on [10 Apr 2014]. The patient was not known to have any chronic disease. He did not have a recent history of travel or contact with animals or with a previously laboratory-confirmed case.

The concerned health authorities in the UAE are conducting investigations into the contacts of the case.

Globally, from September 2012 to date, WHO has been informed of a total of 228 laboratory-confirmed cases of infection with MERS-CoV, including 92 deaths.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[According to the above WHO report, as of 11 Apr 2014 globally, there have been a total of 228 laboratory confirmed cases of MERS-CoV infections including 92 deaths (case fatality rate 40 percent). The above report mentions a single laboratory confirmed case (who died) in UAE in an individual with no identified exposure risk factors (absence of co-morbidities, no history of travel to areas with known MERS-CoV transmission, and no known contact with animals or with a previously laboratory-confirmed case). Media reports surrounding this event in the UAE have mentioned that this individual was a paramedic working in ambulance transport in the UAE (see prior ProMED-mail posts MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI
20140413.2401723 and MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia 20140412.2398280 for media reports on this event).
As previously mentioned one wonders if this indvdual was involved in transport of an individual with undiagnosed MERS-CoV infection.

Of note, the case reported by Jordan in the 11 Apr 2014 WHO Disease Outbreak Notification is a 52-year-old male with co-morbidities who reportedly travelled to Saudi Arabia from 20-29 Mar 2014, became ill on 25 Mar 2014 and visited a hospital in Jeddah, returned to Jordan on
29 Mar 2014, and visited a hospital in Amman on 29 Mar 2014, and again on 2 Apr 2014. As the apparent index case in the current outbreak in Jeddah had a date of onset of illness of 16 Mar 2014 and an HCW in Jeddah had a date of onset of illness on 22 Mar 2014, information on possible in-hospital contacts the Jordanian case may have had would be helpful to determine whether this case is part of the current Jeddah cluster.

This moderator has been unable to reconcile all reports in the above WHO update with information previously reported on the Saudi MOH website and posted previously on ProMED-mail covering the stated period (6-11 Apr 2014). Information correlating these cases with those reported on the Saudi MOH website would be greatly appreciated (information identifying variables such as age and gender were not always available)..

For a map of the area showing Saudi Arabia and the UAE, see <http://healthmap.org/promed/p/131>. - Mod.MPP]

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[3] UAE, colleagues of fatal case - media report 14 Apr 2014
Date: 14 Apr 2014
Source: The National [edited]
<http://www.thenational.ae/uae/health/uae-health-authorities-monitoring-mers-cases-in-filipinos>


Health authorities and Philippine embassy officials in Abu Dhabi are closely monitoring medical staff who may have been infected with the MERS coronavirus. A 45-year-old male died on Thursday [10 Apr 2014] after contracting the virus. Four paramedics and a nurse are in quarantine as a precautionary measure.

"The 5 Filipinos are under observation and are stable, according to the local health authorities," said Grace Princesa, the Philippine ambassador to the UAE. "They're doing well and are recovering."

A team from the embassy went to Al Ain at the weekend to check on the condition of the 5 patients.

An engineer in Al Ain identified the ill as 4 paramedics and one nurse. He confirmed they were still being kept in quarantine but were doing well as of Monday [14 Apr 2014]. The 4 paramedics, 2 men and 2 women, are in Al Ain Hospital, and the nurse, a man from Abu Dhabi, is being treated at Mafraq Hospital.

A friend of all 5, said: "My friends and I have also been screened, and the tests all came back negative for the virus."

[This friend] hosted a birthday party on [3 Apr 2014] attended by [the 45-year-old who died of MERS-CoV]. The paramedic was already suffering from a fever that week. He worked as a paramedic for Al Ain Rescue and Ambulance Section, part of the Ministry of Interior. A few months before his death, he was transferred to its logistics section.

Dr Asim Malik, a consultant and head of infectious disease at Mafraq Hospital, said people with flu-like symptoms such as a fever, cough and shortness of breath are asking doctors to be tested to eliminate the possibility they may have the coronavirus. "The symptoms are just so similar to regular flu," he said. "You cannot differentiate unless you test for it. So it is not unusual that people are coming to be tested. As Ramadan approaches and more people travel to and from Saudi Arabia, I expect more and more people to be tested for MERS-CoV."

Dr Malik said the UAE was prepared to track and control infectious outbreaks and people should remain calm. He said the "number one priority" was for people not to panic and to strictly adhere to advice being issued to the community. "Don't rely on rumours, trust experts, and listen to their advice."

Manila's department of foreign affairs issued an advisory on Monday
[14 Apr 2014] urging Filipinos in the Middle East to take precautions.

Cases of [MERS-CoV infection] have been reported in Saudi Arabia, Qatar, Kuwait, Jordan and Oman.

The department "continues to urge Filipino nationals in affected countries to remain calm and to heed the advice given by local health authorities such as washing hands thoroughly, using sanitisers, and observing other general hygiene practices," the advisory said. It
added: "Those who experience any of the disease's symptoms are urged to immediately seek medical attention."

[Byline: Jennifer Bell and Ramona Ruiz]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The information in the above media report is on the contacts of the case mentioned in the WHO update above (see [2] above). Of note, prior newswires suggested that the 5 individuals who were colleagues of the 45-year-old male who died were asymptomatic (see MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia 20140412.2398280 and MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening 20140410.2395733). The mention in the above newswire that these individuals are "stable" and are "recovering" suggests that there may have been some clinical disease associated with the MERS-CoV infections. Clarification from knowledgeable sources would be greatly appreciated. It is curious that only the fatal case has been reported as a confirmed case of MERS-CoV infection whereas the media continue to report on 6 additional colleagues of this individual as being infected with the MERS-CoV. Clarification of the actual situation would be greatly appreciated.

For a map of the UAE showing the location of Al Ain, see <http://www.mapsofworld.com/united-arab-emirates/maps/uae-map.gif>.
For a map showing the location of the UAE and other countries in the region, see <http://healthmap.org/r/awCA>. - Mod.MPP]

******
[4] Need for transparency - media report
Date: 13 Apr 2014
Source: Arab News [edited]
<http://www.arabnews.com/news/555306>


At a recent get-together, one of our friends surprised us by showing up wearing a medical mask. Another complained that most pharmacies were out of hand sanitizers. All this and much more is perhaps the natural reaction to the reports about the spread of coronavirus or Middle East respiratory syndrome (MERS) in Jeddah.

About a week ago, panic gripped the city when reports about the death of a medical practitioner went public. He died of MERS in one of the government hospitals in Jeddah. In the wake of his death, various rumors started doing the rounds, and, not to be surprised, most of the social media networks went abuzz with different theories.

Frankly speaking, despite the seriousness of this issue, one has to admit that the social media and different online news outlets blew the issue out of proportion. However, the health officials decided to maintain their silence, and perhaps rumors feed on silence. Tweets, Facebook feeds, and WhatsApp messages went crazy with rumors about closure of hospitals, huge numbers of fatalities, and list upon list of health guidelines pouring in from everywhere in cyberspace.

Such a situation always gives rise to (sometimes) unwarranted fears, which grow due to people's natural concern for the safety of their loved ones.

After some delay, the Ministry of Health (MoH) finally broke its silence over the issue. As always, when an official comes forward to contain a situation fatted with rumors, people receive his statements with skepticism. In the era of the fast and furious social media networks, you do not voluntarily give the crowd the chance to tell your side of the story, to speak in your behalf; by doing so, you simply lose your credibility. Despite repeated statements and photos of routine work carried out in various hospitals and official visits to one of the hospitals particularly in the news, there are those who still swear that 4 hospitals have already been closed because of the virus; they have the WhatsApp messages to prove it!

However, the seriousness of the situation cannot be downplayed. The virus that was identified in Saudi Arabia back in April 2012 still remains a mystery. According to the World Health Organization, the coronavirus has not been previously detected in humans, and there is very limited information on its transmission, severity, and clinical impact. As of 27 Mar 2014, there were 206 confirmed MERS cases reported to the WHO, including 86 deaths.

Obviously, we do not know a lot about the virus, such as its development, mode of transmission, and its treatment. Scientists around the world are still working on it. For that, you better have little faith in the series of social media messages spreading several tips on how to protect yourself and your family from it. If you need real information, visit the webpage of MoH, as it has posted some good information and a FAQ about the virus and how to deal with the situation. In a nutshell, it is mostly general guidelines on personal and environmental hygiene.

I really hope the MoH and other government and private organizations take these incidents as a lesson. They need to become part of the lives of those they serve by interacting with them and addressing their fears and concerns. They cannot decide to stand on the line, when the whole game is being played in their backyard.

Moreover, in addition to disaster management, there are more important and pressing issues that the MoH needs to address. Infection control, government hospitals statuses, and medical staff management in such circumstances are all examples of what the officials at the ministry need to revise and address.

[Byline: Saad Dosari]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

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[5] Need for transparency - media report
Date: 14 Apr 2014
Source: Saudi Gazette Op Ed [edited]
<http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20140414201789>


Saudi Arabia in general, and residents of its coastal city Jeddah in particular, have been overwhelmed with very disturbing news about the spread of the coronavirus that has so far claimed 66 lives across the country. What has been shocking and extremely disturbing are the countless stories and rumors that have spread just as quickly and just as aggressively as the virus itself. There was a great deal of panic; maybe a better word to describe the situation would be pandomonia.
There was a clear lack of proper communication and transparency.

The problem has been a while in the making and not new (it has been over 3 years since the 1st case was reported, to be exact) [the 1st laboratory confirmed case was publicly reported on 20 Sep 2012; ProMED-mail post Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733; afterwards, in November 2012, a previously undiagnosed nosocomial outbreak in Jordan that occurred in April 2012 was retrospectively confirmed as having been due to MERS-CoV. - Mod.MPP]. One would have been [re]assured and would wish that at least there would have been a website, Twitter account, and Facebook page dedicated to monitoring the progress of combating the disease and revealing the status of each region as far as the number of cases detected, including the death toll as well.

There were hardly enough public statements to provide the press and the community with the required reassuring information that would put all the whirling rumors to rest once and for all. It is obviously important to highlight that, with the "arrival" of the virus to Jeddah, the challenge will be even greater, as Jeddah is the point of entry and the gateway to the 2 holy mosques, which means a huge number of non-stop visitors around the year from all over the world, simply a massive challenge.

Without proper preparation and adequate communication, the consequences could be nothing short of catastrophic. The challenge and the issue at hand is communication, which seems to be inadequate due to the over simplification of the matter for the fear of anxiety and panic a dedicated communique would cause. It seems that was not a proper conclusion, because the "lack" of it has caused a greater sense of panic.

Saudi Arabia is not the 1st country to be facing a medical "challenge"
of dealing with the spread of viruses and diseases. The Far East was recently entangled with dealing with SARS, bird flu, and swine flu.
They did it with mixed results at best, and this in itself should be a very important learning opportunity to engage with the countries that faced similar challenges and understand the mistakes they made, and what did they do to improve the system.

There is no need to reinvent the wheel at all in this case. It all starts with better communication to bring people out of the dark and put an end to rumors.

[Byline: Hussein Shobokshi]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[When this moderator read the Op Ed piece in [4] above, she had a sense of deja vu from the early days of the SARS outbreak, especially the statement "...and perhaps rumors feed on silence," very reminiscent of a commentary in the British Medical Journal (BMJ) that was posted on ProMED-mail in February of 2003 (see Pneumonia - China
(Guangdong) (07) 20030221.0452). In that report, there was an observation that "...considerable anxiety was created by an "epidemic of rumours." There was mention that "Rumours abounded about the source of the infection..." and "The rumour spread that many of the victims of the illness were hospital staff and that a number of them had died.
... In the absence of public statements and official information, the media communicated very little."

Times have changed, and some of the media today, in the absence of public statements and official information, publish using information that, at times, is just reporting on the circulating rumors.

In the 2nd Op Ed piece in [5] above, the comment: "What has been shocking and extremely disturbing are the countless stories and rumors that have spread just as quickly and just as aggressively as the virus itself," further enhances the argument for the need for transparency.

At the time of the SARS outbreak BMJ commentary (February 2003), this moderator commented: "This is a reminder of the need for official sources to report information on outbreaks and findings of outbreak investigations sooner rather than later. In today's environment, with increased telecommunications worldwide combined with heightened concerns about bioterrorism, news of disease outbreaks travels much faster and more widely than in the past."

The "explosion" in the use of social media in the 10+ years since the SARS outbreak has resulted in a further explosion of rumor mongering to fill the information void. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/131>.]

[See Also:
MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI
20140413.2401723
MERS-CoV - Eastern Mediterranean (28): Jordan, UAE, Saudi Arabia
20140412.2398280
MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening 20140410.2395733 MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763 MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, UAE, RFI
20140408.2390003
MERS-CoV - Eastern Mediterranean (24): Saudi Arabia, RFI
20140406.2385665
MERS-CoV - Eastern Mediterranean (23): Saudi Arabia 20140404.2378035 MERS-CoV - Eastern Mediterranean (22): UAE, WHO 20140401.2373381 MERS-CoV - Eastern Mediterranean (18): Saudi Arabia 20140321.2347610 MERS-CoV - Eastern Mediterranean (17): Kuwait, UAE, Saudi Arabia, WHO, RFI 20140320.2345849 MERS-CoV - Eastern Mediterranean (16): Saudi Arabia, WHO
20140318.2340740
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, WHO, RFI
20140317.2338519
MERS-CoV - Eastern Mediterranean (14): Saudi Arabia, RFI
20140314.2333773
MERS-CoV - Eastern Mediterranean (13): Saudi Arabia, UAE, WHO
20140313.2330878
MERS-CoV - Eastern Mediterranean (12): Saudi Arabia 20140306.2317828 MERS-CoV - Eastern Mediterranean (11): Saudi Arabia, WHO
20140301.2308415
MERS-CoV - Eastern Mediterranean (08): Saudi Arabia 20140220.2289977 MERS-CoV - Eastern Mediterranean (07): Saudi Arabia 20140215.2280653 MERS-CoV - Eastern Mediterranean (06): UAE (Abu Dhabi)
20140208.2264161
MERS-CoV - Eastern Mediterranean (05): Saudi Arabia, WHO
20140203.2252192
MERS-CoV - Eastern Mediterranean (04): Saudi Arabia, Jordan, WHO
20140128.2235722
MERS-CoV - Eastern Mediterranean (03): Oman, WHO 20140109.2162284 MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807 MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO
20140103.2150717
2013
----
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606 MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612 MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat
20131219.2126531
MERS-CoV - Eastern Mediterranean (100): Saudi Arabia, WHO
20131219.2126258
MERS-CoV - Eastern Mediterranean (99): animal reservoir, camel, Qatar
20131217.2120936
MERS-CoV - Eastern Mediterranean (98): animal reserv/camel, Jordan, Saudi Arabia 20131213.2114362 MERS-CoV - Eastern Mediterranean (95): animal reservoir, camel, Qatar
20131129.2082942
MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar
20131129.2082330
MERS-CoV - Eastern Mediterranean (93): animal res., camel conf, Qatar
(RY) OIE 20131129.2082115
MERS-CoV - Eastern Mediterranean (91): Saudi Arabia, WHO
20131127.2078860
MERS-CoV - Eastern Mediterranean (90): Saudi Arabia, Qatar fatal
20131120.2064667
MERS-CoV - Eastern Mediterranean (88): Kuwait, WHO, Spain
20131119.2062587
MERS-CoV Eastern Mediterranean (87): animal res. camel susp.
precautions 20131113.2053932
MERS-CoV - Eastern Mediterranean (86): Kuwait, 1st rep, susp, RFI
20131113.2052320
MERS-CoV - Eastern Mediterranean (85): animal reservoir, camel, susp, official 20131112.2051424 MERS-CoV - Eastern Mediterranean (84): Saudi Arabia, Oman, deaths, WHO, RFI 20131112.2049026 MERS-CoV - Eastern Mediterranean (82): Qatar, RFI 20131110.2047575 MERS-CoV - Eastern Mediterranean (81): Saudi Arabia, UAE ex Oman, RFI
20131108.2044846
MERS-CoV - Eastern Mediterranean (70): Saudi Arabia, WHO
20130913.1936342
MERS-CoV - Eastern Mediterranean (60): Qatar, new case, RFI
20130827.1904425
MERS-CoV - Eastern Mediterranean (51): Saudi Arabia, WHO, RFI
20130801.1857286
MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, WHO
20130709.1813691
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, Italy ex Jordan, WHO, RFI 20130601.1749096 MERS-CoV - Eastern Mediterranean (12): Saudi Arabia, France
20130528.1741836
MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864 Novel coronavirus - Eastern Mediterranean (24): France, 2nd case
20130512.1707305
Novel coronavirus - Eastern Mediterranean (20): France ex UAE, WHO, Saudi Arabia 20130508.1700034 Novel coronavirus - Eastern Mediterranean (14): Germany ex UAE, WHO, fatal 20130326.1604564 Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI
20130323.1600113
Novel coronavirus - Eastern Mediterranean (11): UK, pers to pers transm 20130316.1588808 Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany
20130221.155410
Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp
20130213.1541531
Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan
20130212.1539086
2012
----
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI
20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster
20121123.1421664
Novel coronavirus - Saudi Arabia (14): KSA MOH 20121022.1358297 Novel coronavirus - Saudi Arabia (12): RFI 20121019.1353615 Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012
20120925.1308001
Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
20120923.1305982
Novel coronavirus - Saudi Arabia (02): additional cases, RFI
20120923.1305931
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733] .................................................mpp/msp/mpp
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