Editor's Note: This story was updated in the afternoon of May 9 to report the suspected cases in France.

May 9, 2013 (CIDRAP News) – Saudi Arabian officials reported today that their investigation of a healthcare-associated cluster of novel coronavirus (nCoV) cases has uncovered two more illnesses, increasing the cluster to 15, as France reported two suspected cases related to its first nCoV case, reported yesterday.

The Saudi cases involve a 48-year-old man who is hospitalized in stable condition and a 58-year-old man who recovered and was discharged from the hospital on May 3, according to Ziad A. Memish, MD, Saudi Arabia's deputy minister for public health. He reported the cases via ProMED, the reporting service of the International Society for Infectious Diseases.

The World Health Organization (WHO) confirmed the cases in a statement today and said both patients "are from the same cluster reported since the beginning of May 2013, which is linked to an outbreak in a healthcare facility." Press reports have linked the cases to a hospital in Hofuf, in the country's Eastern province. Seven of the patients have died.

The two cases raise the global total of confirmed nCoV cases to 33 with 18 deaths since the virus emerged in April 2012. Saudi Arabia has been the site of 25 of the 33 cases.

Memish's report said, "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 [May 8]."

Memish said the 58-year-old man fell ill on Apr 6, which is 8 days earlier than the earliest previously reported onset date in the cluster, Apr 14. He also noted that the man had "multiple comorbidities" and that his case/ was confirmed through repeat testing.

The 48-year-old got sick on Apr 29 and also had a comorbidity, according to Memish's report. He did not offer any specifics on how the two cases were related to the others in the cluster.

The WHO noted that the case cluster consists of 12 men and 3 women, with ages ranging from 24 to 94.

The cluster has raised concern about a possible increase in person-to-person transmission of the virus. Several case clusters have been noted previously, but human transmission has been clearly demonstrated only once, in a three-person family cluster in the United Kingdom. No ongoing human transmission has been observed.

Possible nCoV spread in France

In France, meanwhile, a patient who shared a ward with a 65-year-old man who had traveled to the United Arab Emirates and became the country's first nCoV case-patient has also become ill, as has a physician who treated the 65-year-old, Reuters reported today.

The patient shared a ward with the nCoV patient in a hospital in the northern town of Valenciennes at the end of April, and the physician treated the index patient there. The 65-year-old has since been transferred to Lille, where he is in critical condition, the Reuters story said.

"They show symptoms which require a special infectious diseases consultation," the local health authority said in a statement. "The results of the tests carried out on these two people will be known soon and will be made public."

The patient is in his 50s, and the doctor is 35, according to a machine-translated version of an Agence France-Presse (AFP) story.

No change in recommendations

The WHO continued to advise health authorities to be alert for severe respiratory infections, especially in travelers returning from affected countries. The agency does not recommend screening travelers at points of entry or imposing any travel or trade restrictions.

An international team of experts is now in Saudi Arabia at the government's invitation to help investigate the nCoV cases, according to a Canadian Press report today.

Editorial director Jim Wappes contributed to the updated version of this story.

See also:

May 9 Memish report via ProMED

May 9 WHO statement

May 9 Reuters story

May 9 AFP article (in French)

May 9 Canadian Press story