The April surge of MERS-CoV (Middle East respiratory syndrome coronavirus) cases continued today with a report of 16 more in Saudi Arabia, while European health officials observed that the total for this month alone exceeds the total for the preceding 2 years since the disease emerged.

Saudi Arabia described cases in seven cities around the country, with only three in Jeddah, which has been the major hot spot lately. None of the latest cases were fatal, but two previously reported patients have died, the government said.

Meanwhile, the European Centre for Disease Prevention and Control (ECDC) said its global count of MERS-CoV cases reported in April reached 217 yesterday, compared with 207 reported in all previous months since the disease surfaced in 2012.

Latest cases widely scattered

In a statement posted today, the Saudi Ministry of Health (MOH) said the 16 new cases include 7 in Riyadh, 2 in Tabuk, 1 in Mecca, 3 in Jeddah, 1 in Najran, 1 in Hafr Al-Batin, and 1 in Medina. Most of those cities have had other cases this month, but the one in Hafr Al-Batin is the first there since July 2013, according to a case list maintained by FluTrackers, an infectious disease message board.

The MOH today continued its new practice of sharing much more information than it did before a new acting health minister, Adel Faqih, was appointed last week. Today's statement on the new cases included a map and graphs showing patients' age and gender distribution and previous health status.

Ten of the 16 patients have preexisting health conditions, the MOH said. Three patients were described as asymptomatic, 6 are in stable condition, and 7 are being treated in intensive care units.

The statement said 5 patents are in the age range of 25 to 44 years, 4 are between 45 and 64, and 7 are 65 or older. Nine patients had contact with other MERS case-patients, but none were reported to have had contact with animals.

For the second day in a row, none of the new patients were described as healthcare workers (HCWs), which contrasts with the general pattern of the past few weeks. For example, among the 26 cases announced by the MOH on Apr 26 and 27, 9 were HCWs, and 4 of 14 reported on Apr 25 were in that category. On Apr 24, 5 of 12 newly reported cases involved HCWs.

The two deaths in previously reported cases involved a 41-year-old man in Tabuk and an 88-year-old man in Riyadh.

The latest cases raise Saudi Arabia's posted MERS count to 361 cases and 107 deaths.

April case count dwarfs previous tallies

In an epidemiologic update today, the ECDC said its tally of MERS cases has reached 424, including 217 in this month alone, with just 207 in the previous 2 years. The total does not include the 16 cases reported by Saudi Arabia today.

The 217 cases reported this month include 179 in Saudi Arabia, 32 in the United Arab Emirates, 2 in Jordan, and 1 each in Egypt, Greece, Malaysia, and the Philippines, the agency said.

The ECDC also reported that out of 95 HCWs infected with MERS-CoV in the past 2 years, 62 (65%) cases occurred this month, which amounts to about 29% of the 217 cases for the month.

Of the 95 HCW cases, Saudi Arabia accounted for 70 (74%), the United Arab Emirates (UAE) for 23 (24%), and the Philippines and Jordan for 1 each, according to the report. The UAE had a recent cluster of cases among paramedics.

Experts have been unable to explain the recent increase in cases. So far, genetic sequencing of recent MERS-CoV isolates has revealed no significant mutations. Some suspect a seasonal pattern to the disease, since this year's increase echoes the emergence of the disease in the spring of 2012 and a surge of cases in April and May of last year.

The virus is fairly common in camels in the Middle East, and some experts suspect that the increase in human cases is related to an increase in the population of young camels, since camels give birth in the winter.

Camels and MERS-CoV denialism

In related news, the MERS risk has prompted the new Saudi health minister to warn people against direct contact with camels, but some Saudi Arabians who own and work with camels are reluctant to buy the notion that the animals have anything to do with the disease, according to media reports.

Besides warning against direct contact with camels, the minister said people should be careful when handling raw camel meat and should boil camel milk before drinking it, the Saudi Gazette reported today. He spoke yesterday after a meeting of Western experts and WHO officials.

Traders and workers in Riyadh's sprawling camel market said the government has given them no advice or warnings about MERS, and they expressed disbelief in any camel link to the disease, according to a Reuters story yesterday. "It's a lie," one trader said. "We live with camels, we drink their milk, we eat their meat. There’s no disease."

Although the World Health Organization has been advising that people who have risk factors for severe MERS-CoV should consider avoiding camels, the topic has been mostly absent from the debate inside Saudi Arabia, the story said. It noted that camels are beloved in Saudi Arabia and closely bound to the country's cultural identity, providing a link to its nomadic tradition.

See also:

Apr 30 Saudi MOH statement on new cases

Apr 30 ECDC report

Apr 30 Saudi Gazette story

Apr 29 Reuters story