NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (21): SAUDI ARABIA 2 more confirmed

A ProMED-mail post
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Date: Thu 9 May 2013
From: Ziad Memish [edited]


Urgent update on nCoV cluster in KSA [Kingdom of Saudi Arabia]
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The investigation of the recent cluster in Alhassa [Al-Hasa or Al-Ahsa], KSA is still ongoing. Actions implemented and fully applied by 1 May 2013 have been effective to date in preventing NEW cases related to this cluster from emerging. But in-depth look back and search among contacts of earlier reported cases and repeat testing of suspected cases revealed 2 new cases yesterday [8 May 2013]:

- Case 14: 48-year-old male with multiple comorbidities. Start of symptoms 29 Apr 2013 and confirmed by lab testing. He is in stable condition in hospital.

Case 15: 58-year-old male with comorbidity. Start of symptoms 6 Apr 2013. His repeat testing was positive and he fully recovered and was discharged on 3 May 2013.

The investigation is ongoing and more details will be released as they arise.
--
Ziad A Memish,MD,FRCP(Can),FRCP(Edin),FRCP(Lond),FACP
Deputy Minister for Public Health
Director WHO Collaborating Center for Mass Gathering Medicine
Ministry of Health
Professor, College of Medicine
Alfaisal University
Riyadh 11176
Kingdom of Saudi Arabia


[ProMED-mail would like to thank Dr Memish for the rapid sharing of this information. The addition of these 2 newly identified cases brings the total number of cases associated with this cluster in Al-Hasa, Eastern Province to 15.

As with the previously identified 13 cases, these cases have a history of comorbidities suggesting they were in the implicated health care facility (HCF) for a different admitting diagnosis and they were infected with the nCoV while in the HCF.

This brings the global total of confirmed cases of nCoV to 33.  http://www.promedmail.org/direct.php?id=20130509.1701527

Dubai health centres told to probe Sars-like cases

DHA assured the situation is being closely monitored; since September 2012 to date, WHO confirms 31 cases, including 18 deaths

By 

Bindu Suresh Rai

Published Thursday, May 09, 2013

The Dubai Health Authority (DHA) has asked healthcare institutions to investigate any Sars-like symptoms in patients after France on Wednesday reported its first case of the deadly coronavirus in a patient who had recently returned from the UAE.

The 65-year-old Frenchman has been shifted to an isolation ward in Paris, where he is currently undergoing treatment, as per agency reports.

The tourist returned to the French capital on April 17 after reportedly spending a week in Dubai; but it is unclear where he contracted the deadly coronavirus, which is from the same viral family that triggered the outbreak of Severe Acute Respiratory Syndrome or Sars in Asia killing 775 people.

The DHA issued a statement in light of this new case, with the spokesperson saying: “We have been keeping a close eye on the situation since the World Health Organisation first reported the disease outbreak last year.

“The DHA in collaboration with Ministry of Health is closely following the WGO and Centre of Disease control and Prevention (USA) protocols.”

In a message to local health centres, the DHA spokesperson added: “All health institutions are aware of the virus and its symptoms. We urge health institutions to investigate any cases of people who have symptoms of serious lung infection like pneumonia and this is a protocol that is being followed internationally.

“Besides, health and other relevant authorities in the UAE are taking all necessary measures.”

The spokesperson reiterated that the WHO has not issued any travel guidelines that people need to follow as of now, “especially with regard to countries such as Saudi Arabia, where a majority of the cases have been identified.”

While the authority assured that the situation is being closely monitored, a statement from the MoH is awaited after Emirates 24|7 contacted them.

Meanwhile, it has been reported that WHO officials are expected to visit a Saudi Arabian hospital where the Sars-like virus has claimed the lives of seven people and four still remain critically ill, while two are recovering, as per WHO update.

A total of 23 cases have been reported in Saudi in the past six months, with cases also emerging in Jordan, Qatar, Britain and Germany.

The French case brings total known infections worldwide to 31, of which 18 have died.

Symptoms of this new strain include severe lung infection and pneumonia-like conditions.
 http://www.emirates247.com/news/emirates/dubai-health-centres-told-to-probe-sars-like-cases-2013-05-09-1.505848

In the same context, he stressed Hashim bin Mohammed Hassan Al Bin Sheikh, a brother of the infected with the virus similar to one for completely cure the disease, and proof of a negative HIV infection in his sister's analyzes, while the deteriorated state of health of his brother, the other yesterday afternoon, 
He explained Hashem's "home" that he had received yesterday a phone call from the Department of Hospital "Aramco" medical in the province of Dhahran, stating heal his brother "Hussein", has allowed medical team to his brother to get out of the hospital, at the same time received a benefit from the medical team to his brother, the other "Abdullah" infected with the same virus and is undergoing treatment in a private hospital in Al-Ahsa, indicate that the case of his brother-in-degradation, and necessitated increasing the proportion of oxygen from 4% to 15%. 
Among the results of laboratory tests and samples to his sister, which was Tnoimha in King Fahd Hospital in Hofuf after a sudden rise in body temperature, proved HIV negative, and that the high temperature caused by being infected with the "flu" normal. 
He drew Hashim petition to officials in the Ministry of Health and Saudi Aramco, the transfer of all people living with HIV to a hospital Aramco in Dhahran, the fact that the hospital Aramco in Dhahran able to deal with the virus, and succeeded medical team there in the elimination of the virus, stressing that he and his family were in constant contact with the Hospital specialists Aramco Dhahran to receive the other brother. He recalled the circumstances injuring his two brothers with HIV, and said wounded when visiting their father, who was منوما in a private hospital Ahsa in intensive care as a result of a drop in sugar, and they were Azorana clock, and assist him or her in taking his medication, pointing out that his father retired staff member at Aramco, Medical and Public at this hospital. Adding that father was منوما in hypnosis room with 5 other cases, all of whom were receiving treatment through artificial breathing apparatus. He mentioned in his talk that his family requested the transfer of his father to complete the treatment in a hospital Aramco Medical Center in Dhahran, but the hospital where his father was receiving treatment for it, he told them that the hospital Aramco refused to receive the case, and it turns them later that the hospital Aramco OK to receive the case. 

Saudi Arabia calls for SARS virus experts to face the strange disease

On Thursday, May 9, 2013

تتمتع الدكتورة أليسون ماك جي بخبرة بفيروس سارز الذي يشبه الفيروس الغامض الذي اكتشف في مشفى في الهفوف

Enjoy Dr. Alison McG experience with SARS virus, which resembles the mysterious virus, which was discovered in a hospital in Hofuf
I arrived yesterday to Saudi Arabia, a Canadian doctor from a range of experts, at the request of the Kingdom of the SARS virus experts to help in the face of a new virus after an outbreak of a mysterious disease in Hofuf in the Eastern Province, according to New Scientist site, which mention the name of the hospital in Hofuf.



And enjoy Dr. Alison McG expertly virus SARS-like virus mysterious discovered in hospital after an injury 13 cases World Health Organization confirmed that resemble virus SARS risk according to a statement of the organization indicated that the re-emergence of the virus and the pattern moving remarkable in Saudi Arabia increases the concern about this virus , calls the research level of friction infected patient and the degree of exposure, because of injury, as well as the source of the virus and the prevalence in the region, which are an urgent call for answers is under follow-up by the Saudi Ministry of Health.


In addition to Allison, the two officials will meet with the World Health Organization (WHO) officials and the Saudi Ministry of Health in the capital, Riyadh, and likely a spokesman for the organization that they had visited a hospital in the area of ​​Hofuf in Saudi Arabia and is considered the hospital point spread of the virus.

This comes after a French tourist injury mysterious disease. Reuters quoted the French Health Ministry said on Wednesday it detected the first cases of a new strain of the virus coronal coming from the Middle East in the person recently returned from the United Arab Emirates.

The ministry said it had opened an investigation as she confirmed the first case of the new virus in France. The patient was isolated.

The World Health Organisation (WHO) said that 30 cases of HIV infection were confirmed experimentally, of which 18 died since scientists discovered the disease in September. http://arabic.arabianbusiness.com/society/healthcare/2013/may/9/331046/#.UYtvgbVwe5I

Virus similar to SARS: The patient transferred to Lille in stable condition

The northerner patient with novel coronavirus, SARS close, first confirmed case in France, was in stable condition Thursday but still very serious, the ICU of University Hospital of Lille, where he was transferred in the night from Wednesday to Thursday . HUGUEN PHILIPPE AFP

Updated 05/09/13 at 11:14

The northerner patient with novel coronavirus, SARS close, first confirmed case in France, was in stable condition Thursday but still very serious, the ICU of University Hospital of Lille, where he was transferred in the night from Wednesday to Thursday .

This 65 year old patient transferred to 1:30 in the morning, "was immediately placed in a chamber designed to allow its isolation," where he was supported by a dedicated team, said the Lille University Hospital.

The patient was hospitalized on April 23 in Valenciennes (North), then transferred to Douai April 29. He had stayed in Dubai (United Arab Emirates) from 9 to 17 April. Before his hospitalization, he was followed to the hospital in Valenciennes for a chronic disease.

According to ARS Lille, no cases of the disease have been detected in his entourage.

The man, who has respiratory failure requiring the introduction Wednesday of cardiopulmonary support to take over his lung function is in a "stable" condition, but requires "careful monitoring", according the University Hospital of Lille.

"As has been transferred, that he was in a stable condition, but it is like all ICU patients in a very serious condition," said the AFP Sandrine Segovia Kueny, Deputy Director General of ARS.

The French case comes ten years after the epidemic of SARS (Severe Acute Respiratory Syndrome), part of China, which had killed more than 800 people and caused concern in the world.

Before the announcement of the existence of this patient in France, cases of infection were detected in Saudi Arabia, Jordan, the United Kingdom and Germany.

About the virus, generally Benoit Guery, Head of Infectious Diseases Hospital in Lille Thursday morning confided his "concern" on France Inter, "because we find ourselves still with respiratory syndromes that have a severity important. It was still two-thirds of deaths in the number of cases. "

However, it noted the "small number of cases": "The good news somewhere, is that we are now in May 2013 (the virus) was released in April 2012 and it has still failed to emerge more significantly. "

A total of 30 confirmed cases in the world of this novel coronavirus have been reported to WHO since September 2012 and 18 people died. 22 cases including 13 deaths, have been identified in Saudi Arabia, two cases (both deceased) in Jordan, four including two deaths in the United Kingdom, and two cases with one death in Germany, had said Wednesday Dr. Françoise Weber, Director the Institute of Health.

"We must wait, we are absolutely not in a very important warning, but there is a potential danger," concluded Mr. Guery.

Coronaviruses are a large family of viruses that cause a wide range of human diseases, ranging from common cold to SARS.

The new coronavirus - NCoV in medical jargon - was detected for the first time in mid-2012. This is a particular strain that had never been identified in humans or animals.

Patients presenting with symptoms of severe acute respiratory infection with fever, cough, shortness of breath and difficulty breathing.

The Ministry of Health has set up a hotline for Wednesday, 0800 13 00 00, to inform the public. http://www.20minutes.fr/ledirect/1152337/20130509-virus-proche-sras-patient-francais-transfere-a-lille

CDC Update, Case Definitions, and Guidance Update

Update, Case Definitions, and Guidance

Update

CDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk presented by recently reported cases of infection with a novel coronavirus. As of May 8, 2013, 31 laboratory-confirmed cases have been reported to WHO - 22 from Saudi Arabia, two from Qatar, two from Jordan, three from the United Kingdom, one from the United Arab Emirates, and one from France. The onset of illness was between April 2012 and May 2013 (1). Among the 31 cases, 18 were fatal. Two of the 31 cases experienced a mild respiratory illness and fully recovered.

Clusters of cases in Saudi Arabia, Jordan and the United Kingdom are being investigated. 

The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for the novel coronavirus. This cluster was temporally associated with cases of illness among workers in a hospital (2).

 A second cluster occurred in October 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory-confirmed cases, two of them died. 

In February 2013, a third cluster of three family members was identified in the United Kingdom. All three people tested positive for novel coronavirus. Among them, two died, and one recovered after experiencing a mild respiratory illness. This cluster provides evidence of person-to-person transmission of novel coronavirus. It also provides the first example of mild illness being associated with novel coronavirus infection.

 A fourth cluster among two family contacts occurred in Saudi Arabia in February 2013. One of the individuals died, and one recovered after experiencing a mild respiratory illness. 

In May 2013, a fifth cluster was reported in Saudi Arabia and is linked to one healthcare facility. A total of 13 cases have been reported in the cluster, of which seven have died. The Kingdom of Saudi Arabia Ministry of Health is investigating the situation.

There is clear evidence of limited, not sustained, human-to-human transmission, possibly involving different modes of transmission such as droplet and contact transmission. But further studies are required to better understand the risks. The efficiency of person-to-person transmission of novel coronavirus is not well characterized but appears to be low, given the small number of confirmed cases since the discovery of the virus.

The reservoir and route of transmission of the novel coronavirus are still being investigated. Genetic sequencing to date has determined the virus is most closely related to coronaviruses detected in bats. CDC is continuing to collaborate with WHO and affected countries to better characterize the epidemiology of novel coronavirus infection in humans.

Case Definitions(2)

Patient Under Investigation (PUI)

CDC requests that state and local health departments report PUIs for novel coronavirus to CDC.

• A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND
• suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation); AND
• history of travel from the Arabian Peninsula or neighboring countries* within 10 days; AND
• not already explained by any other infection or etiology, including all clinically indicated tests forcommunity-acquired pneumonia** according to local management guidelines.

In addition, the following persons may be considered for evaluation for novel coronavirus infection:

• Persons who develop severe acute lower respiratory illness of known etiology within 10 days after travel from the Arabian Peninsula or neighboring countries*but do not respond to appropriate therapy; OR
• Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 10 days after travel from the Arabian Peninsula or neighboring countries*. Close contact is defined as providing care for the ill traveler (e.g., a healthcare worker or family member), or having similar close physical contact; or stayed at the same place (e.g. lived with, visited) as the traveler while the traveler was ill.

For more information, see Interim Guidance for State and Local Health Departments.

http://www.cdc.gov/coronavirus/ncv/case-def.html#update

SARS Coronavirus: the 65 year old man hospitalized in Douai, transferred to Lille

The University Hospital of Lille has more appropriate than Douai way to treat a patient whose lungs work more practically.  

• By Emmanuel Pall
• Published 08/05/2013 | 4:17 p.m. , updated on 08/05/2013 | 7:05 p.m.

© PHILIPPE HUGUEN / AFP

His blood is being oxygenated by a machine. Unconscious, he is being transferred to the University Hospital of Lille in resuscitation in the emergency department. His departure from Douai delayed his arrival in Lille should be done in the evening. His prognosis is engaged.  It was during an accreditation from 9 to 17 April in the United Arab that this 65 year old man contracted Coronavirus Emirates travel.

It is presented for digestive disorders Valenciennes Hospital on April 23. Respiratory disorders arrived around April 28 with significant impairment of respiratory functions April 30. He, between these two dates was transferred to Douai.

"The passengers of the plane are all safe"

Early May analyzes allowed to know that the patient had Coronavirus.  His family and those who flew with him were contacted by the Regional Health Agency. They are healthy and will remain, according to the ARS, as virus symptoms appear after 10 days.  http://nord-pas-de-calais.france3.fr/2013/05/08/sras-coronavirus-l-homme-de-65-ans-hospitalise-douai-va-etre-transfere-lille-248101.html  

Coronavirus: a Northern 65 remains hospitalized in Douai due to surgery (VIDEO)

PUBLISHED ON 08/05/2013

By La Voix du Nord

One case of acute respiratory coronavirus infection, the virus again near SARS (severe acute respiratory syndrome) was confirmed in France, announced the Ministry of Health. The patient, a native of the south of department Nord (59), was hospitalized in Douai. It should be conducted this afternoon at Lille but the transfer was canceled due to surgery. His prognosis is engaged.

• 
• - A +

What has happened?

"This is the first and only confirmed case in France to date" of this new virus coronavirus family, the ministry said, noting it involved "a person back from a trip to the United Arab Emirates . "  The case was confirmed Tuesday. On Wednesday evening, he is still in hospital in Douai. His health prevented his transfer to Lille during the afternoon. The ambulance had the express trip, turned back empty because it was undergoing at the same time surgery.

What is the profile of the patient?

According to information from the Regional Health Agency, the man is 65 years old. It lies in the northern department, rather in the southern part. was hospitalized on April 23 in Valenciennes, Douai and then transferred to 29 April, where he was placed in solitary confinement and in intensive care and benefits of "respite care "or respiratory assistance and" blood trade, "said Jean-Yves Grall, Director General of Health, at a press conference.The man had stayed in Dubai from April 9 to 17 for a family vacation, he said. He was hospitalized with acute respiratory disease.

In what state he is?

The symptoms are similar to those of pneumonia. To treat it, doctors have installed an artificial membrane that allows it to breathe. The patient is intubated and ventilated asleep. "It worries us," concedes Dr. Patrick Goldstein, head of the center's Emergency University Hospital of Lille. The individual was particularly fragile as it was regularly monitored in the hospital for a gastrointestinal disease Valenciennes before being contaminated. Tonight, a source familiar with the matter told us that his condition requiressurgery. His prognosis is engaged.

Should we worry about the rest of the population?

No, the virus is very contagious. It affected only 30 people, of which 17 died within a year and a half. According to doctors, "the virus is less infectious than SARS but more deadly. "

After testing, we got the certainty that the patient's family is not affected by the virus. The staff of the hospital who are approached closely monitored without having found anything.So there is no reason to panic. In case of contamination, the symptoms appear after 10 days. There is currently no treatment.  

A freephone number 0800 13 00 00, "was open this afternoon for the French find answers to their questions," said for his part the Minister of Health Marisol Touraine.

What is this virus?

The new coronavirus - nCoV in medical jargon - was detected for the first time in mid-2012.Cases of infection with the new coronavirus had so far been detected in Saudi Arabia, Jordan, the United Kingdom and Germany. It affects mostly men (78%) with a mean age of 54 years and who already have a compromised immune system due to disease.

It owes its name, coronavirus, its particular shape of a crown. 

Already in 2003 ...

An outbreak of SARS (Severe Acute Respiratory Syndrome) has killed more than 800 people in China in 2003, triggering a health alert worldwide.  The new virus is different, however, SARS, especially because it causes rapid kidney failure. At the time, the first French patient was also a northerner. 

Human spillover dangers grow as flu in pigs rises

Thursday, May 09, 2013 Scientists say flu infections are rising among pigs raised for slaughter on farms in south and southeastern China, which is also plagued by bird flu.And the risk of spillover to humans is "constant or growing," according to an author of a study published in the journal Proceedings of the Royal Society B. Pigs are an important source of new human strains of influenza A, such as the 2009-10 H1N1 pandemic that emerged in Mexico and infected an estimated fifth of the world's population. Pigs can act as a "mixing vessel" in a process known as reassortment, brewing new flu strains from swine, poultry and human viruses in areas where they live in close proximity. Such new hybrids can be deadly - tens of millions of people died in flu pandemics in 1918, 1957 and 1968. The 2009 strain, though highly infectious, was about as lethal as the ordinary seasonal flu. China is in the grip of an H7N9 bird flu virus that has killed 27 people, mainly in the east, overlapping with the study area. An international team of experts analyzed data collected at an abattoir in Hong Kong over a 12-year period from 1998 to 2010, to learn more about the spread of flu among pigs. http://www.thestandard.com.hk/news_detail.asp?we_cat=3&art_id=133556&sid=39632513&con_type=1&d_str=20130509&fc=4

Probe: Coronavirus spread from tainted dialysis machine

Last updated: Wednesday, May 08, 2013 11:44 PM

  

HOFUF — The primary cause for the corona virus that spread in a private hospital in this Eastern Province city killing seven people and infecting six others in the past two weeks was a contaminated dialysis equipment, the local media reported on Wednesday.

Quoting informed medical and health sources, Al-Watan newspaper said an investigation committee formed to determine the causes of the coronavirus noted that a number of workers in the hospital did not observe the international rules necessary for combating epidemics.

The Ministry of Health on Sunday said it was in close contact with the World Health Organization (WHO) to find out more about the new type of the coronavirus.

The spread of the virus caused panic among the residents and led to a state of alert in the region’s health affairs departments.

A relative of one victim who died of the virus said the patient was not suffering from any serious illness when he was admitted to the private hospital for dialysis three times a week.

“A few days after he was admitted to the hospital for dialysis, the doctors told us that his health condition was deteriorating. Two days later our relative died,” he said.

The sources said another patient who got the virus was improving and was admitted to another hospital from which he would not be discharged before two weeks.

They said the other five patients who contracted the virus were currently receiving intensive treatment but their condition was not stable.

Deputy Health Minister Dr. Mansour Al-Hawasi visited a number of hospitals in Al-Ahsa on Tuesday to follow up the procedures being taken to curb the spread of the virus.

He later briefed the region’s Governor Prince Badr Bin Mohammed Bin Jalawi on the health situation in the region.

The head of the applied medical sciences at the community college in Najran Dr. Abdul Rahman Al-Qurashi said the coronavirus was one of the fast spreading viruses and described it as very serious according to international standards.

He said it was very difficult to analyze the virus because it soon turns into crystal balls that look like pieces of salt or sugar. 

He blamed the existence of the virus in the Kingdom on a variety of reasons including travel abroad. http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20130509164933

General / Ministry of Health: Survey measures have so far limited the emergence of new cases of Corona virus in the province of Hasa

The ministry said in a press statement today that through reviewing cases of previous infection that have been announced and contacts them, who took them samples precedent on 19 Jumada II 1434 AH announced record two cases of this disease for the citizens of one old (58 years) has been cured and discharged from hospital two days ago and the other age (42) years old and still in the hospital under treatment and in stable condition. http://www.spa.gov.sa/details.php?id=1108312

Additional cases of novel coronavirus observed in Saudi Arabia

LISTEN / DOWNLOAD

The World Health Organization

The Ministry of Health of Saudi Arabia has informed the World Health Organization (WHO) that there are three more laboratory-confirmed cases of infection with the novel coronavirus (nCoV).

NCoV is a respiratory ailment that appeared in September 2012 in a previously health 49 year old Qatari male who had travelled to Saudi Arabia before becoming sick.

The Qatari case was a near clinical match to the case of a Saudi man who had died of novel coronavirus earlier in 2012.

Glenn Thomas is with the World Health Organization.

“The Ministry of Health in Saudi Arabia has informed WHO two of the patients died on Friday the 3rd of May and one is currently in critical condition. The Saudi Arabian Government is conducting on-going investigations into this outbreak, which is linked to one health care facility in Al-hazah. Since the beginning of May, a total of 13 patients have been reported from this outbreak, of which seven have died.”

To date, Glenn Thomas says WHO has been informed of a global total of 30 laboratory-confirmed cases of human infection with novel coronavirus, including 18 deaths.

Gerry Adams, United Nations.

Duration: 1’18″

France reports first SARS-like virus case | Video | Reuters.com

http://www.reuters.com/video/2013/05/08/france-reports-first-sars-like-virus-cas?videoId=242681602&videoChannel=117760

WHO experts to visit Saudi hospital where coronavirus spread

• 
  By Stephanie Nebehay and Mahmoud Habboush

GENEVA/DUBAI | Wed May 8, 2013 4:01pm BST

(Reuters) - World Health Organization (WHO) experts and local officials will visit a Saudi hospital where the SARS-like coronavirus has spread, killing seven people, the U.N. agency said on Wednesday.

France reported its first case on Wednesday in a 65-year-old Frenchman who had recently returned from Dubai with the virus that has emerged from the Gulf and has also spread to Britain and Germany as well as Jordan, Qatar and United Arab Emirates.

The French case brings total known infections worldwide to 31, of which 18 have died.The Saudi patients appeared to have been infected in hospital with some family members also falling ill, WHO officials said.

Coronavirus is from the same viral family as triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world from Asia in late 2003, killing 775 people.

Health experts' concerns are growing over clusters of cases, despite no evidence of sustained human-to-human transmission - the type of infection pathway that can lead to pandemics.

The WHO-Saudi team of experts will focus on the Al-Moosa hospital in the town of Hofuf in Ahsa governate in Eastern Province, where the patients are being treated. Official statements released via the Saudi Press Agency have sought to reassure Saudis the outbreak is limited.

"One focal point of the investigation at the moment is the haemodialysis unit in the hospital," said WHO spokesman Gregory Hartl in Geneva, referring to equipment used on kidney and diabetes patients.

"The association of this outbreak with a single health care facility suggests nosocomial (hospital-acquired) transmission," it said, noting that some patients under treatment for ailments may have had increased susceptibility to infection.

"However, the presence of infection in two family members not associated with the facility itself raises a concern about potential broader transmission in the community," it said.

Saudi Arabia's Health Ministry spokesman did not respond to repeated phone calls seeking comment, while the director at Al-Moussa declined to comment. International media were not invited to a news conference with Health Ministry officials on Monday.

Statements on official media outlets were aimed at dispelling online speculation in Saudi Arabiathat the virus had spread to other hospitals in Eastern Province.

A total of 23 cases have been reported since September in Saudi Arabia, including 13 since mid-April in al-Ahsa, where seven patients have died and four remain critically ill in intensive care, with two improving in hospital, the WHO said.

SPREADING TO EUROPE

Along with the French case, the WHO has registered 23 cases in Saudi Arabia, two in Jordan, two in Qatar, one in the United Arab Emirates (UAE) and two in Britain.

France's Health Minister Marisol Touraine said the man, now on a respirator in an intensive care ward, was admitted to hospital with breathing problems and a fever on April 23, a few days after his return from a week-long trip to Dubai.

"This is an imported case and it's a unique case," Touraine told a news conference, promising a thorough investigation into how the man had become infected.

Tests were now being carried out as a precaution on all friends and relatives who had been in contact with him, but all have come up negative so far, officials said.

"He is in a critical condition. His situation is worrying," the government's health director Jean-Yves Grall told the news conference. The man, who is from the northern Nord Pas de Calais region, has needed blood transfusions, he said.

The most recent German case was in March. The man fell ill in UAE and went to Germany for treatment where he died. The previous case, in November, was a man who was infected in Qatar, treated in Germany and then discharged from hospital.

(Additional reporting by Angus McDowall in Riyadh and James Regan in Paris; Editing by LouiseIreland and Catherine Bremer) http://uk.reuters.com/article/2013/05/08/uk-coronavirus-idUKBRE9470O420130508?feedType=RSS&feedName=worldNews

England travel update-Novel coronavirus 2012: update on cases in Saudi Arabia

8 May 2013

Novel coronavirus 2012: update on cases in Saudi Arabia

This updates the previous Clinical Update of 27 March 2013

Since the beginning of May 2013, the Ministry of Health in Saudi Arabia has informed the World Health Organization (WHO) of 13 new laboratory confirmed cases of novel coronavirus (nCoV) infection, including seven deaths [1-2].

As of 6 May 2013, 30 cases of human infection with novel coronavirus (nCoV) have been reported to WHO (two from Jordan, two from Qatar, 23 from Saudi Arabia, one from the United Arab Emirates and two, associated with transmission from imported cases, in the United Kingdom (UK);18 of these 30 cases have died [1-3].

Sustained community transmission of the virus has not been observed; human-to-human transmission has occurred in at least one of four clusters of cases [3].  Although some cases have had animal exposures, information on zoonotic transmission remains limited, and a specific animal reservoir has not been identified. Investigations are on-going [4].

WHO is currently working with international experts and countries where cases have been reported, to assess the situation and review recommendations for surveillance and monitoring.

Advice for travellers

There continue to be no travel restrictions to the Middle East and the risk to travellers remains very low. Travellers returning from the Middle East and surrounding countries, with mild respiratory symptoms are most likely to have a common respiratory illness such as a cold.  However, if severe respiratory symptoms develop, such as shortness of breath, within ten days of returning from these countries, medical advice should be sought from their GP or NHS 111. Returning travellers should mention which countries they have visited.

The risk of UK residents contracting infection in the UK is very low.

Advice for health professionals

Health professionals should, as always, take a detailed travel history when evaluating an ill returned traveller. The level of risk in those who come to the UK from, or return from, the Middle East and meet the case definition for a “case under investigation” is very low but warrants testing for novel coronavirus infection. The probability that a cluster of cases of severe acute respiratory infection of unexplained aetiology requiring intensive care admission is due to novel coronavirus remains very low, but warrants testing.

Public Health England (PHE) has developed advice for health professionals in relation to novel coronavirus 2012, including a case definition for investigation and management of patients, and infection control advice. Where patients meet the possible case definition, clinicians should inform their local PHE Centres which will be able to assist in the risk assessment and advise on what samples should be taken. These risk assessments will continue to be reviewed frequently in response to any further cases of novel coronavirus.

Standard transmission based precautions for respiratory tract infections should be instituted if a possible case is suspected.

Clinical queries about the management of potential cases of severe respiratory infections in people who have recently visited Saudi Arabia, Qatar or Jordan, or the neighbouring countries of Bahrain, Iraq, Israel, Kuwait, Lebanon, Oman, Syria, UAE and Yemen, should be directed in the first instance to the local infectious disease physician or microbiologists.  The nationalImported Fever Service is available to local infectious disease physicians or microbiologists should specialist advice be needed (0844 7788990)..

http://www.nathnac.org/pro/clinical_updates/corona_080513.htm