Coronavirus in the Kingdom of Saudi Arabia

Nov 6, 2012 | David Scales | Outbreak News

The Saudi Arabian Deputy Minister of Health, Ziad Memish, reported a third case of a novel coronavirus appearing in the capital Riyadh. He reported the discovery via the infectious disease surveillance listserve ProMED, and a message in Arabic (translation) was posted on the Saudi Ministry of Health website.

So far three cases of this new virus have been identified in the past few months. The first occurred in June, when a 60 year-old man was admitted to a hospital in Jeddah. After an 11-day hospitalization, he developed kidney failure and died, as reported in a New England Journal of Medicine article. The second case previously appeared on the Disease Daily. A 49 year-old Qatari man in Northern England became seriously ill and was transferred to a London hospital in early September. He had visited Riyadh in August.

Little is known about this third infection except that the man affected was placed in intensive care for serious pneumonia. Currently recovering, the Saudi Ministry of Health reported that the patient had no travel history outside of Riyadh. He had recently visited a farm but what kind of animals he may have had contact with was not described.

Saudi health officials urge people not to worry (link in Arabic, translation) as the virus does not appear transmissible from person to person. Officials in the UK traced 64 of the Qatari man’s contacts – people who potentially could have become infected with the virus due to contact with the infected man. None of them had serious symptoms. Thirteen contacts had mild respiratory symptoms within 10 days of exposure, but all recovered. Ten of the individuals with symptoms were tested, but none were found to have the novel coronavirus.

Public health officials worldwide have reason to take the matter seriously. First, all of those affected were previously healthy individuals that became severely ill with pneumonia. Second, the virus responsible is a coronavirus – the same family of virus as SARS, which caused 750 deaths and infected over 8,000 people during a global outbreak in 2003. The virus that caused SARS came from a small mammal called a civet. Since many coronaviruses come from animals, there is precedent for animal-related viruses to cause pandemics in humans.

Finally, a new virus appearing in Saudi Arabia poses a particular challenge for public health officials due to the yearly Hajj pilgrimage. Pilgrims arrived in the Kingdom towards the end of October and are not required to leave until Nov. 29. A spokesman for the Saudi Ministry of Health hoped to alleviate worries about Hajj-related transmission by confirming that the latest victim was not a Hajj pilgrim and had not travelled to areas in western Saudi Arabia associated with the pilgrimage.

Not all coronaviruses are as dangerous as SARS, however – coronaviruses also cause the common cold. Yet much is still unknown about this virus, including its origin. Research teams have sequenced the genetic code, showing it to be similar to a virus that infects bats. At least two of the three patients had known interaction with animals, including sheep and camels, within the Kingdom prior to becoming ill. Since none of the three cases had direct contact with bats, researchers believe another mammal is likely an intermediary.

A diagnostic test has already been developed by the same team that developed a diagnostic test for SARS (here’s a report about how made the test so quickly). The test is still undergoing verification for its potential value in clinical situations.

For more information, download this PDF for the Weekly Epidemiological Record from the WHO, which contains requirements and recommendations for the 2012 Hajj season, and follow the epidemiological situation on HealthMap’s Hajj risk map.

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