FW: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (31): Saudi Arabia, Malaysia, Philippines

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Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (31): Saudi Arabia, Malaysia, Philippines


MERS-COV - EASTERN MEDITERRANEAN (31): SAUDI ARABIA, MALAYSIA, PHILIPPINES
**************************************************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases <http://www.isid.org>

In this update:
[1] Malaysia ex Saudi Arabia, 1 death
[2] Saudi Arabia, Jeddah, 6 new cases, 1 death MOH 16 Apr 2014 [3] Saudi Arabia, Jeddah, 5 new cases, 1 death MOH 15 Apr 2014 [4] Saudi Arabia, update on Jeddah outbreak 37 cases, 7 deaths [5] Saudi Arabia, update on 194 cases (69 deaths) [6] UAE, 10 new cases WHO [7] Philippines ex UAE, asymptomatic

******
[1] Malaysia ex Saudi Arabia, 1 death
Date: 16 Apr 2014
Source: The Star [edited]
<http://www.thestar.com.my/News/Nation/2014/04/16/MERS-detected-in-malaysia/>


The Middle East respiratory syndrome-coronavirus (MERS-CoV) has killed its 1st victim in Asia, a Malaysian man who developed respiratory complications after returning from Mecca.

The 54-year-old man, from Batu Pahat, Johor, had arrived in Malaysia on [29 Mar 2014] after performing the Umrah. He died on [13 Apr 2014] after being admitted to the Hospital Sultanah Nora Ismail for 3 days, following complaints of fever, cough and breathing difficulties.

Passengers on-board the Turkish Airlines flights TK93 and TK60 on the Jeddah-Istanbul-Kuala Lumpur route on [29 Mar 2014] are urged to contact the Health Ministry for a health screening, said Health Minister Datuk Seri Dr S. Subramaniam.

The MERS-CoV was 1st detected in the Middle East in 2012, but researchers have yet to determine its cause [the "cause" is the MERS associated coronavirus, what is still not fully identified is the route of transmission for the sporadic and index cases. - Mod.MPP].

The World Health Organization has recorded 238 cases of the disease and 92 deaths related to the MERS-CoV globally to date.

[Byline: Lee Yen Mun]

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

[This is the 1st confirmation of a MERS-CoV infection in a returning pilgrim from Saudi Arabia in Malaysia. Information on possible risk factors/exposures of this individual including all places visited during the pilgrimage, contact with other individuals who may have had respiratory disease, possible contacts with animals, especially camels while there, as well as history of prior co-morbidities that may have pre-disposed to more severe illness would be very much appreciated by ProMED-mail.

For a map of Malaysia, see <http://healthmap.org/r/awCL>. - Mod.MPP]

******
[2] Saudi Arabia, Jeddah, 6 new cases, 1 death MOH 16 Apr 2014
Date: 16 Apr 2014
Source: Saudi MOH [edited]
<http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-16-001.aspx>


In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health, the MOH announces the confirmation of 6 new cases of MERS-CoV infection in Jeddah.

The 1st is a 54-year-old citizen receiving intensive care treatment.
The 2nd is a 52-year-old male citizen who has passed away.
The 3rd is a 41-year-old male resident in stable condition.
The 4th is a 44-year-old male resident in stable condition.
The 5th is a 28-year-old male citizen working in the health field, and his condition is stable.
The 6th is a 35-year-old male resident working in the health field, and his condition is stable.

Of 200 samples tested, the above 6 were the only positive cases.

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

[These newly reported cases bring the total number of laboratory confirmed MERS-CoV infected individuals in Saudi Arabia to 205, including 71 deaths, and the total number of cases reported in the ongoing transmission in Jeddah up to 37. Of note, 2 of the 6 cases were in health care workers [HWC]. See the report contained in [4] with more information on the profile of the Jeddah outbreak.

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

******
[3] Saudi Arabia, Jeddah, 5 new cases, 1 death MOH 15 Apr 2014
Date: 15 Apr 2014
Source: Saudi MOH [in Arabic, machine trans., edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-15-002.aspx>


In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for MERS-CoV, the Ministry announces the registration of 5 cases of MERS-CoV infection in Jeddah.

The 1st is a 30-year-old male resident who has recovered.
The 2nd is a 59-year-old male citizen who passed way.
The 3rd is a 64-year-old male resident who works in the health sector whose condition is stable.
The 4th and 5th cases are both 27-year-old females working in the health sector and who are asymptomatic.

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

[Of note, 3 of the 5 cases reported on [15 Apr 2014] were health care workers (HCWs). - Mod.MPP]

******
[4] Saudi Arabia, update on Jeddah outbreak, 37 cases, 7 deaths
Date: 16 Apr 2014
Source: Saudi Press Agency [in Arabic, trans. by Proj.Man.ZH, edited] <http://www.spa.gov.sa/details.php?id=1221501>


The Ministry of Health, represented by members of the National Committee for Infectious Diseases conducted a satellite meeting with experts from the WHO in Geneva and Cairo within the ministry's efforts to follow up on updates on MERS CoV. The meeting showcased MERS CoV cases that were detected in Jeddah province and confirmed that all procedures taken were aligned with the type and pattern of disease.

The ministry provided WHO in Geneva with the recorded cases as of March 2014; the following have been diagnosed: 37 positive MERS CoV cases in 5 hospitals in Jeddah province after testing 2517 specimen of patients and their [contacts]. Work is still underway for more tests for suspected cases and their [contacts], noting that 2 cases had been recorded in Jeddah before that date.

The ministry also declared that according to their records, 21 cases of healthcare workers were recorded, 15 of which were without symptoms, and 9 of which are believe to have contracted the disease from the community. Six [of those healthcare workers] had contact with patients, and one case was a household contact but does not have any symptoms according to the epidemiological surveillance/investigation by that date. Of the total cases recorded in Jeddah, 7 died, and those cases were recorded according to their primary [location of transmission] and source of infection.

In Jeddah, there were 3 cases confirmed in Hospital A; the source for the 1st case is from the community, and the other 2 were [presumably healthcare workers].

Hospital B had 2 cases, and their [presumed] sources were from the community.
Hospital C had one case presumed sourced from the community.
Hospital D had one case who is a healthcare worker thought to have contracted the disease in the community.
Hospital E recorded 30 cases, 19 of which were healthcare workers, 4 cases presumed to be community-acquired, one case sourced from a household contact, and 6 cases were contacts [who presumably visited the cases while in the hospital].

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

[According to the above report, 57 percent (21 out of 37 cases) of the laboratory confirmed cases of MERS-CoV infection in this current outbreak in Jeddah are in healthcare workers (HCWs). Of these 21 HCWs,
71 percent (15) were asymptomatic and were diagnosed as part of contact tracing activities conducted by the Saudi MOH. Looking at the hospital breakdown, it appears as though Hospital E has the majority of the MERS-CoV cases -- 81 percent (30 out of 37 cases) -- as well as the majority of the cases seen in HCWs, 90 percent (19 out of 21). - Mod.MPP]

******
[5] Saudi Arabia, update on 194 cases (69 deaths)
Date: Tue 15 Apr 2014
Source: Saudi Arabia Ministry of Health [in Arabic trans. Proj.Man.ZH, edited] <http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-04-15-001.aspx>


Members of the National Scientific Committee for Infectious Diseases [NSCID] confirmed that the health status in Jeddah city is reassuring [after an evaluation of the situation in the governorate of Jeddah] and that the clustering of cases found in the city is actually in line with the nature of the disease, which tends to affect an aggregate of cases, and the infection pattern of the virus does not differ from that in the rest of the Kingdom. The members also added that the preparedness of hospitals and healthcare facilities follows national and international infection control standards and does not need any additional preparation, as all necessary machines and supplies required to treat cases are available.

This was surmised during [after] an investigational visit conducted by a team of the NSCID, who represent several health sectors from within and outside the Ministry of Health [MoH]. [This visit targeted] hospitals in the city of Jeddah [with the objective] of monitoring the health status, hospital preparedness with regards to MERS-CoV, and meeting a group of healthcare providers in these facilities.

Additionally, the Minister of Health, Dr Abdullah Al-Rabiah, met this morning [15 Apr 2014] with NSCID committee members at the library in Jeddah. Also present at the meeting were Deputy Minister for Health Affairs Dr Mansour Al-Hawasi and Deputy Minister for Planning and Development Dr Mohammed Khashim. [The meeting] discussed latest developments in the city, as well as efforts undertaken by the Ministry of Health to renew and ensure communication with vaccine-manufacturing companies and international research centers to discuss the development of an effective vaccine for MERS-CoV and the willingness of the Ministry of Health and the national scientific committee to collaborate in this regard.

The Minister of Health was also briefed on the Ministry of Health report on the status of MERS-CoV since its detection. The report pointed out that MERS-CoV is an emerging disease, similar to other emerging diseases such as H1N1 influenza virus in 2009 and the SARS virus in 2003, and that these diseases are challenging; it takes time for scientists to identify the source of infection and means of transmission and to develop a drug that can treat the disease as well as a vaccine to prevent it, all of which apply to MERS-CoV. The 1st case was recorded in the Kingdom of Saudi Arabia in June 2012, in a patient with respiratory symptoms from the province of Bisha who sought treatment in Jeddah. A sample from the patient was sent to a laboratory in Europe, which concluded that it was a new disease caused by a virus of the coronavirus family.

Following receipt of this information, the ministry called on members of the National Committee of Scientific Infectious Disease -- consisting of consultants in infectious diseases and family medicine as well as community and public health representatives of all health authorities in the Kingdom, the Ministries of Defense, the National Guard, Interior, Education, and Health and the Faculty of Medicine at King Saud University, King Faisal Specialist Hospital, and Saudi Aramco [Saudi Arabian Oil Co] -- to put forth preventive policies. The Ministry of Health initiated surveillance and studies on the epidemiology of the disease in all regions of the Kingdom as well as preparing the reference laboratories in Jeddah, Dammam, Riyadh, Medina, and Mecca to receive the samples.

The report also pointed out that the disease was recorded in several countries in the Middle East and that the Ministry of Health and national scientific committee consulted with experts and specialists from WHO and other international entities and universities, some of whom participated with the MoH in the field to the study the disease.

As for the history of epidemiological surveillance of the disease, the report discussed the recordings of individual and scattered cases, the clustering of a few cases among family members where there was no spread of infection (such as the case in Bisha and other scattered cases in Riyadh). In April 2013, and for the 1st time, a cluster of cases was recorded in a hospital in Al-Ahsa province among individuals with compromised immune systems, resulting in the transmission of infection among some of these patients. The virus then was recorded in the eastern region in hospitals run by Saudi Aramco. These cases in Al-Ahsa and the eastern region were under control. During the 2nd half of March 2014, King Fahd Hospital in Jeddah started recording cases that amounted to 26 in addition to 2 other cases recorded earlier.
Currently, there are MoH teams working around the clock to implement infection control measures, [including] disinfection as well as continuing efforts to prevent the spread of disease. The report gave assurances that the MoH is still monitoring the disease and is doing what is necessary to deal with it.

The report also noted that the ministry only announces cases after laboratory confirmation and re-examination in reference laboratories inside and outside of the country to confirm the results. It also notes that this disease has no vaccine or preventive treatment, that the source of the virus is still unknown, and that the contagion and how infection is transmitted from one person to another are also as of yet unknown. Research to identify the source of primary infection is still ongoing, as samples from camels and their handlers are being taken in several regions of the Kingdom, in collaboration with the Ministry of Agriculture. The results of this research will be announced upon completion.

As for the epidemiological surveillance of MERS-CoV infections, the number of confirmed cases to date is 194 cases, including 69 deaths, bringing the case fatality rate to 35 percent, whereas in the earlier days, the case fatality rate was almost 60 percent, which is less than the international case fatality rate of 41.5 percent. To date 12 out of 20 districts and provinces have recorded MERS-CoV cases. The largest number of cases has been reported in Riyadh with 82 cases, and a case fatality rate of 42.2 percent, followed by the province of Jeddah with 28 cases and a case fatality rate of 14.4 percent, Al-Ahsa province with 25 cases and a case fatality rate of 12.8 percent, and the eastern region with 23 cases and a case fatality rate of 11.8 percent.

The distribution of cases by regions and provinces is as follows:

Region or province: number of cases
Al-Ahsa: 25
Aseer: 7
Bisha: 1
Eastern region: 23
Hafr-Al-Batin: 11
Jeddah: 28
Al-Jof: 2
Al-Madinah: 7
Najran: 1
Al-Qassim: 2
Riyadh: 82
Al-Taif: 5
Total: 194

As for gender and nationality distribution among cases, males represent the largest number with 127 cases or 65.5 percent, with females having 67 cases or 34.5 percent. 158 cases were Saudis (81.5
percent) and 36 were non-Saudis (18.5 percent).

As for the distribution of cases by different health sectors, the report indicated that the following health sectors recorded cases:
Ministries of Defense, National Guard, Interior and Health, as well as the private sector, university hospitals, and Saudi Aramco [hospital].
A breakdown of the cases by sector shows that the Ministry of Health hospitals recorded 72 cases, the Ministry of Defense hospitals 39 cases, the Ministry of National Guard hospitals 30 cases, security forces hospitals 4 cases, university hospitals 5 cases, Aramco hospitals 14 cases, private health sector hospitals 20 cases, the King Faisal Specialist hospitals in Riyadh and Jeddah 10 cases, since the onset of the disease in 2012. The report also pointed out that the cases recorded in the Ministry of Health hospitals include both patients as well as their contacts with positive results in both hospitals of the Ministry of Health and hospitals in the other sectors. The following table shows the distribution of these cases:

Health sector: number of cases
Ministry of Health hospitals (includes patients and their contacts who tested positive): 72 Department of Defense hospitals: 39 National Guard hospitals: 30 Security forces hospitals: 4 Saudi Aramco hospitals: 14 Private hospitals: 20 University hospitals: 5 King Faisal Specialist hospitals in Riyadh and Jeddah: 10
Total: 194

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

[The summary update above is a helpful synopsis of the current situation in Saudi Arabia, providing a glimpse at the geographic distribution of cases both in terms of administrative divisions around the country as well as within the various health sectors in the country, including public as well as private healthcare providing institutions. It appears as though cases are not being hospitalized in all geographical locations, but they are occurring in most sectors, including public and private hospitals, the petrol industry facilities, and the military sector.

Hopefully, moving forward, these types of epidemiologic information will be updated as new cases are reported.

For a map of Saudi Arabia, see <http://healthmap.org/promed/p/131>.
For a map showing administrative divisions in Saudi Arabia, see <http://www.worldofmaps.net/en/middle-east/map-saudi-arabia/map-administrative-divisions-saudi-arabia.htm>.
- Mod.MPP]

******
[6] UAE, 10 cases WHO 16 Apr 2014
Date: 16 Apr 2014
Source: WHO Global Alert and Response [edited] <http://who.int/csr/don/2014_04_16_mers/en/>


On [13 and 14 Apr 2014], United Arab Emirates (UAE) reported a cluster of 10 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection among health-care workers identified through screening of contacts of a previously laboratory-confirmed case from Abu Dhabi who died on [10 Apr 2014].

The following details were provided to WHO:
- A 37-year-old woman from Abu Dhabi with no reported underlying medical condition. She was screened and hospitalized on [9 Apr 2014] with mild illness.
- A 41-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014].
- A 43-year-old woman from Abu Dhabi with underlying medical conditions. She was screened and hospitalized on [9 Apr 2014] with mild illness.
- A 33-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014] with mild illness.
- A 46-year-old man from Abu Dhabi with underlying medical conditions.
He was screened and hospitalized on [9 Apr 2014] with mild illness.
- A 48-year-old man from Abu Dhabi with underlying medical conditions.
He was screened and hospitalized on [9 Apr 2014] with symptoms of pneumonia.
- A 37-year-old man from in Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [9 Apr 2014] with mild illness.
- A 43-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [10 Apr 2014] without any illness.
- A 27-year-old man from Abu Dhabi with underlying medical conditions.
He was screened and hospitalized on [10 Apr 2014] without any illness.
- A 43-year-old man from Abu Dhabi with no reported underlying medical condition. He was screened and hospitalized on [10 Apr 2014] without any illness.

Currently, all the cases are in stable condition, and their family and health care contacts are being followed up.

Globally, from September 2012 to date, WHO has been informed of a total of 238 laboratory-confirmed cases of infection with MERS-CoV, including 92 deaths.

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

[Of note is a reminder that the 10 newly confirmed cases in the UAE mentioned in the above WHO report were all identified as part of contract tracing for the epidemiologic investigation surrounding the fatal case in a Filippino paramedic working in the UAE. Of these 10 contacts found to be positive for MERS-CoV infection, 5 were described as having "mild illness," 3 were described as asymptomatic, one was noted to have pneumonia, and for one there is no mention of clinical status. If there had not been contact screening, it is highly likely that as many as 8 of the 10 MERS-CoV infected individuals might not have been identified as they had mild or no clinical illness.

For a map showing the location of the UAE and other countries in the region, see <http://healthmap.org/r/awCA>. - Mod.MPP]

******
[7] Philippines ex UAE, asymptomatic infection
Date: 16 Apr 2014
Source: ABS-CBNnews.com [edited]
<http://www.abs-cbnnews.com/nation/04/16/14/ofw-uae-tests-positive-mers-cov>


An overseas Filipino worker (OFW) who arrived in Manila Tuesday [15 Apr 2014] from the United Arab Emirates (UAE) tested positive for the Middle East respiratory syndrome-coronavirus (MERS-COV).

Four members of his family from the UAE have been quarantined plus the
5 people who fetched him at the airport.

Even though these 10 people have not exhibited symptoms of MERS-COV, Ona said they have been placed under isolation to prevent the possible spread of the virus.

"They are now in isolation together with the family. All of them are without symptoms," he said.

He explained that the OFW, a nurse, tested positive for MERS-COV after he was exposed to the Filipino paramedic who died from the disease in Al Ain.

He said the Department of Health (DOH) received the information regarding the nurse from its counterparts in the UAE.

The OFW nurse and his relatives will have to undergo separate tests during their stay at an undisclosed hospital. The results of the tests will be issued on Friday or Saturday [18-19 Apr 2014].

"Since they are symptom-less, we are just doing some preventive measures. We will give them medicines once they exhibit symptoms," he said. The incubation period of the virus is 10 to 14 days.

At the moment, there is no vaccine against MERS-CoV, he said.

Ona said the DOH is "contact-tracing" those who were near or had been in contact with the OFW. "We need to observe them so that they can undergo tests," he said.

So far, authorities have been able to contact those in front, at the back, and those beside the OFW on the plane from UAE to Manila. Ona assured the public that there is no need to panic. "I don't even think a travel restriction to and from UAE is necessary," he said.

The Bureau of Quarantine will strictly implement monitoring procedures, he said. He also said the DOH will be sending an epidemiology expert and an infectious disease specialist to the UAE to assist the Filipinos there.

"The decision to send these health experts was made to look into the situation where a Filipino health worker died and 6 others were found to be positive, as reported by health authorities of the country of origin," the DOH said.

The DOH also urged the OFWs with respiratory illnesses to see their healthcare providers. It also reminded the public to observe frequent handwashing and to cover their mouths when coughing.

The World Health Organization (WHO) says the symptoms of MERS-CoV include fever, cough, shortness of breath, and even diarrhea.

Human cases of MERS-CoV have also been reported in other Middle Eastern countries, such as Saudi Arabia, Qatar, Kuwait, Jordan and Oman.

[Byline: Adrian Ayalin]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This incident serves as a reminder that we live in a global village and that microbial organisms can travel worldwide silently. Had the UAE not done contact tracing, this individual might never have been identified in a potential chain of transmission. But it should be pointed out here that at present, there is no evidence documenting that asymptomatic individuals infected with the MERS-CoV are transmitters of the virus to other individuals.

For a map of the Philippines, see <http://healthmap.org/r/awCM>.

>From the multiple laboratory confirmations of MERS-CoV infection that
have been reported in recent weeks, it does appear as though MERS-CoV activity is increasing. There was mention that MERS-CoV activity may be somewhat seasonal as there was an increase in MERS-CoV cases in Saudi Arabia around this time of year in 2013 as well, and April 2012 was when the 1st nosocomial outbreak occurred (the outbreak in Jordan that was retrospectively diagnosed once the novel coronavirus had been identified). There has also been a significant amount of concern vocalized about the possibility of "super spreaders" similar to what was seen in SARS, and the possibility of a change in the virus leading to more easy transmission. What should also be mentioned is the addage of "seek and ye shall find," and with increased awareness, it is quite possible that many more cases are being identified that might not have been previously.- Mod.MPP]

[See Also:
MERS-CoV - Eastern Mediterranean (30): Saudi Arabia, UAE, WHO, RFI
20140414.2403986
MERS-CoV - Eastern Mediterranean (29): Saudi Arabia, Yemen, UAE, RFI
20140413.2401723
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20140318.2340740
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, WHO, RFI
20140317.2338519
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20140314.2333773
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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
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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/zh/mj/mpp/msp/zh/mpp/msp/mpp
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