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Published Date: 2012-09-25 09:53:20
Subject: PRO/AH/EDR> Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012
Archive Number: 20120925.1308001

NOVEL CORONAVIRUS - SAUDI ARABIA (04): REQUEST FOR INFORMATION, JORDAN, APRIL 2012
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Date: Sun 23 Sep 2012
From: Irene Lai <irene.lai@internationalsos.com> [edited]

I would be interested to know whether the outbreak of severe respiratory disease of unknown origin in Jordan in April [2012] is now being reviewed for evidence of this new coronavirus.

The HPA UK reports (http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120923acuterespiratoryillnessidentified/) seem to indicate that the cases under review were only those that occurred since July [2012]. "We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past 3 months."

This ECDC report from May [2012] (http://ecdc.europa.eu/en/publications/Publications/CDTR%20online%20version%204%20May%202012.pdf):
Severe respiratory disease of unknown origin - Jordan - Outbreak in ICU
Opening date: [26 Apr 2012] Latest update: 3 May 2012

Epidemiological summary
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An outbreak of a respiratory illness was reported on [19 Apr 2012] by the Ministry of Health in an intensive care unit in a hospital in Zarqa, Jordan. 7 nurses and one doctor were among the 11 affected. One of the nurses died. Jordan's Ministry of Health acknowledges the fatal case specifying she had underlying conditions and all cases had high fever and lower respiratory symptoms. According to the Ministry, the origin of the infection is likely to be viral. However, laboratory results are not available to date.

ECDC assessment
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ECDC is following this event due to its severity including one fatality and the unusualness of the disease affecting healthcare staff. These cases drew high media attention this week [week of 3 May 2012].

Actions
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ECDC contacted both Episouth, WHO, and US CDC for further information. Both WHO and US CDC are following this event.

--
Communicated by:
Irene Lai MD
Medical Director
Medical Information and Analysis
International SOS
Level 3, 45 Clarence Street
Sydney NSW 2000
<irene.lai@internationalsos.com>

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[2]
Date: Sun 22 Apr 2012
Source: Jordan Times [edited]
http://jordantimes.com/Infectious+disease+outbreak+under+control+%E2%80%94+Wreikat-47253

Emergency team searching for cause of unidentified illness
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The disease that broke out in the Intensive Care Unit of Zarqa Public Hospital late last week [week of 19 Apr 2012] has not yet been identified, but the outbreak is under control, Minster of Health Abdul Latif Wreikat said on Sunday [22 Apr 2012].

The ministry on Friday [20 Apr 2012] closed the hospital's ICU after an unknown illness believed to be pneumonia affected 7 nurses, one of whom died on Thursday [19 Apr 2012], one doctor, and the brother of one of the nurses.

The minister said that so far, only 11 people have been confirmed infected with the disease, 4 of whom are receiving treatment and responding positively to medication, while 6 others have already been discharged from the hospital.

The ministry has set up an emergency team from its Communicable Diseases Directorate to investigate the cause of the illness, he said.

"The ministry's team took samples from the infected citizens, who also underwent intensive care measures to identify the cause," Wreikat told reporters at a press conference on Sunday [22 Apr 2012], noting that the infected patients' symptoms are similar to those of pneumonia.

The minister, who visited the Zarqa hospital on Saturday [21 Apr 2012], said the ministry has confirmed that the outbreak has been brought under control and that the infected individuals are not in danger of spreading the disease to others.

Meanwhile, the minister said, the hospital has been sterilised 3 times over the past 3 days as a precautionary measure, while its employees have received a short, intensive training course on preventing the disease from spreading.

He also urged the media to be cautious and objective in reporting on the outbreak.

[Byline: Hani Hazaimeh]

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

[ProMED-mail would like to thank Dr Lai for raising this very astute query and for alerting us to this prior report of an earlier outbreak of severe respiratory disease in the region. This moderator has checked the WHO archives and the ProMED-mail archives and could not find reports on the above mentioned outbreak. The ECDC report is the only formal report on this outbreak. A retrospective search of HealthMap Alerts from 2 Apr 2012 through 25 Apr 2012 looking for reports of pneumonia outbreaks that might be related to this current event only identified a report on the above mentioned outbreak in Jordan in April 2012.

There are a series of newswire reports in the Jordanian Times on this event at the time of the outbreak -- the report above in [2] is a comprehensive discussion of the event. Another report the preceding day (21 Apr 2012) highlighted the fact that after the 1st severe case, staff were not using adequate infection control measures, especially an absence of use of masks (see http://jordantimes.com/zarqa-hospital-icu-closed-after-nurse-dies-from-infection). From these reports, it appears as though the outbreak in Jordan was a nosocomial outbreak involving healthcare personnel working in an ICU where presumably a patient with a severe pneumonia had been hospitalized -- quite possibly related to deficiencies in respiratory infection control measures.

It would be of interest to know if the etiology of the outbreak was ever identified, along with more information on the epidemiologic studies conducted at the time. Information on the index case in that outbreak would be of interest as well.

The interactive HealthMap/ProMED map of the region can be found at http://healthmap.org/r/1HAJ. As can be seen on the map, Jordan shares borders with Saudi Arabia to the east and southeast, Iraq to the northeast, Syria to the north, and the West Bank and Israel to the west. - Mod.MPP]

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