Saudi Arabia reported eight more MERS-CoV (Middle East respiratory syndrome coronavirus) cases yesterday and today, three of them causing no symptoms, and Florida officials announced today that the second US MERS patient has been released from an Orlando hospital.

The Saudi Ministry of Health (MOH) said five earlier MERS patients have died. The new cases and fatalities raised the country's MERS count to 537 cases and 173 deaths.

The latest confirmed cases include 3 in Riyadh, 3 in Jeddah, 1 in Medina, and 1 in Taif. All four cities have had other cases recently, and Jeddah and Riyadh have been the leading MERS hot spots this spring.

All but one of the new case-patients are men, and their age range is fairly narrow: 31 to 52 years. Along with the three asymptomatic patients, four patients are in stable condition and one is being treated in an intensive care unit, the MOH said.

Five patients—3 in Jeddah and 2 in Riyadh—had contact with other MERS patients. But in line with recent practice, the MOH did not say whether any of them are healthcare workers (HCWs).

The five patients who died as a result of MERS cases that were reported earlier were in Mecca, Jeddah, Riyadh, Tabuk, and Taif.

One of the cases reported yesterday involved a 37-year-old man who was hospitalized in Jeddah on May 9 and was discharged from the hospital on May 17, against medical advice. He is currently in stable condition and isolated at home, the MOH said.

That case echoed one reported May 17, in which a 36-year-old Medina man was hospitalized on May 13 but was discharged against medical advice on the 15th. A day later he was admitted to another hospital.

Florida patient out of hospital

Also today, a Florida man who had the second US MERS case has recovered and been released from the hospital, the Florida Department of Health (DOH) in Orange County announced today. He was treated at Dr. P. Phillips Hospital in Orlando.

The DOH said the man has tested negative for the virus, as have all his HCW and household contacts.

The patient, age 44, is a health worker who has been living and working in Saudi Arabia. He first had symptoms on May 1 during the first leg of a trip from Jeddah to Orlando. He was hospitalized at Dr. P. Phillips on May 9.

Officials have said the Florida man's case is not linked to the first US case, involving another American HCW who was living and working in Saudi Arabia. He left Riyadh on Apr 24 to visit relatives in Indiana. On Apr 28 he was hospitalized in Munster, Ind.; where he subsequently recovered and was discharged on May 10.

On May 17 US officials reported that an Illinois business associate of the Indiana patient apparently caught the virus from him, heralding the first secondary MERS case in the country. The Illinois man had only mild cold-like symptoms, but he tested positive for MERS-CoV antibodies. He had met with the Indiana man on two successive days in late April.

More info on second Dutch case

In other news, the World Health Organization (WHO) on May 16 offered a few new details on the Netherlands' second MERS case, in a Dutch woman who traveled to Saudi Arabia with a Dutchman who contracted the virus before she did. The two, described as close relatives, shared a hotel room during their 2-week trip.

The woman is 73 years old and had preexisting health conditions, the WHO said. She had her first symptoms, including breathing difficulties, on May 5 in Mecca. On returning home on May 10, she had mild respiratory symptoms and fever but did not seek medical care.

But she was evaluated and tested in the course of the contact investigation sparked by her companion's case, which led to a preliminary finding that she is infected, the WHO said. The agency said she is in stable condition with fever and mild respiratory symptoms and is hospitalized in isolation.

Imported health workers and exported MERS cases

In other developments, a Reuters story yesterday said the number of foreign HCWs working in Saudi Arabia has soared in recent years, increasing the risk of exportation of MERS cases from the kingdom to other countries, as has been seen with the first two US cases.

The story said recruiters and people who work in Saudi hospitals estimate that about 15% of doctors in Saudi Arabia are American or European and about 40% of nurses are Filipino or Malaysian.

The country is building hundreds of hospitals and scrambling to staff them with qualified personnel, according to Reuters. Recruiters said foreign healthcare professionals who take jobs in the country typically receive free transportation home, housing, and 10 weeks of paid vacation per year.

Recruiting firms told Reuters that the MERS situation has had almost no impact on HCWs' willingness to work in Saudi Arabia.

Meanwhile, the WHO's Regional Office for Europe predicted in a May 15 MERS update that cases will probably continue to be exported from the Middle East to other countries, including those in Europe. But it also said that the risk of spread of MERS-CoV in countries receiving such cases remains low.

See also:

May 19 Saudi MOH statement on new cases

May 18 Saudi MOH statement on new cases

May 19 Florida DOH statement

May 16 WHO statement on second Dutch case

May 18 Reuters story about foreign HCWs in Saudi Arabia

May 16 WHO Europe update on MERS