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Published Date: 2013-05-22 11:56:17
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (07): Tunisia ex Saudi Arabia/Qatar, fatal, WHO
Archive Number: 20130522.1730663

MERS-COV - EASTERN MEDITERRANEAN (07): TUNISIA ex SAUDI ARABIA/QATAR, FATAL, WHO
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Date: Wed 22 May 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_05_22_ncov/en/index.html


Novel coronavirus infection - update 22 May 2013
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The Ministry of Health in Tunisia has notified WHO of 2 laboratory-confirmed cases and a probable case of infection with the novel coronavirus (nCoV) [MERS-CoV].

The 2 laboratory confirmed cases are a 34-year-old man and a 35-year-old woman. They are siblings. Both of them had mild respiratory illness and did not require hospitalization. Retrospective investigation into the cases revealed that the probable case, their father, 66 years old, became ill 3 days after returning from a visit to Qatar and Saudi Arabia on 3 May 2013. He was admitted to a hospital after developing acute respiratory disease. His condition deteriorated and he died on 10 May 2013. He had an underlying health condition. Initial laboratory tests conducted on the probable case tested negative for nCoV [MERS-CoV].

Further investigation into this outbreak is ongoing and close contacts of the family are being monitored for any unusual signs of illness. These are the 1st confirmed cases of infection with nCoV [MERS-CoV] in Tunisia.

In Saudi Arabia, a patient earlier reported as part of the ongoing investigation into an outbreak that began in a health care facility since the beginning of April 2013, has died. To date, a total of 22 patients including 10 deaths have been reported from this outbreak in the Eastern part of Saudi Arabia. The government is conducting an ongoing investigation into the outbreak.

Globally, from September 2012 to date, WHO has been informed of a total of 43 laboratory-confirmed cases of infection with nCoV, including 21 deaths. Several countries in the Middle East have been affected. They are Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). Cases have also been reported by 4 additional countries: France, Germany, Tunisia, and the United Kingdom. All of the cases have had a direct or indirect connection to the Middle East, including 2 cases with recent travel history from the UAE. In France and the United Kingdom, there has been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a traveler who recently returned from the Middle East.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Health care providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for nCoV as advised in the current surveillance recommendations. Specimens from patients' lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that nCoV [MERS-CoV] infection should be considered even with atypical signs and symptoms, such as diarrhoea, particularly in patients who are immunocompromised.

Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients with suspected nCoV [MERS-CoV] infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.

All Member States are reminded to promptly assess and notify WHO of any new case of infection with nCoV [MERS-CoV], along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

WHO continues to closely monitor the situation.

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Communicated by:
ProMED-mail
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[According to this WHO statement, the previously reported fatality in Tunisia has not been laboratory confirmed, but given the clinical presentation, and the laboratory confirmation of MERS-CoV infection in the patient's 2 adult children who accompanied him on his trip to Qatar and Saudi Arabia, the case is being classified as a probable case. Hence, the global total of laboratory confirmed cases of MERS-CoV infection is 43, including 21 deaths -- a case fatality rate of 48.8.

For a map showing the location of Monastir, Tunisia (the location where the probable case was hospitalized), see http://www.mappi.net/img/tunisie/carte_tunisie_route_riviere_aeroport.gif. It is a coastal city located to the south east of the capital Tunis.

For the map showing the Middle East Region, see below. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1HAJ.]

See Also

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MERS-CoV - Eastern Mediterranean (02): WHO summary, ECDC risk assessments 20130518.1721873
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Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI 20130323.1600113
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Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany 20130221.155410
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Novel coronavirus - Eastern Mediterranean (05): UK, 3rd case, 20130215.1544940
Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp 20130213.1541531
Novel coronavirus - Eastern Med. (03): Saudi comment 20130212.1540011
Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan 20130212.1539086
Novel coronavirus - Eastern Mediterranean: bat reservoir 20130122.1508656
2012
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Novel coronavirus - Eastern Mediterranean (06): comments 20121225.1468821
Novel coronavirus - Eastern Mediterranean (05): WHO, transmission route 20121223.1465597
Novel coronavirus - Eastern Mediterranean (04): receptor charact. 20121211.1446670
Novel coronavirus - Eastern Mediterranean (03): research, ISARIC (UK) 20121208.1443486
Novel coronavirus - Eastern Mediterranean (02): diagnostics 20121207.1442473
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
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Novel coronavirus - Saudi Arabia (09): real-time RT-PCR, addition 20120929.1315725
Novel coronavirus - Saudi Arabia (08): real-time RT-PCR assay 20120928.1314254
Novel coronavirus - Saudi Arabia (07): Eurosurveillance reports 20120928.1313337
Novel coronavirus - Saudi Arabia (06) 20120927.1311743
Novel coronavirus - Saudi Arabia (05): WHO, case def., nomenclature 20120926.1309747
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
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