Robert Roos at CIDRAP clarifies a murky situation: Saudi official says labs failed to report MERS cases. Excerpt:
[Tariq] Madani told Reuters that 58 of the 113 belatedly reported MERS cases were confirmed in government hospitals or labs, but they did not inform the MOH. Another 22 cases were confirmed at King Faisal Specialist Hospital in Jeddah, but the hospital didn't tell the MOH and didn't send duplicate samples to government labs, he said.
Conflicting test results were the reason for the delayed reporting of the other 33 cases, Madani reported. Samples from those patients tested positive in private labs but negative in government labs, he explained.
Previously the MOH policy was that if MERS-CoV test results from private and government labs conflicted, the government results ruled, Madani told Reuters. The new health minister, Adel Fakieh, has changed the policy so that a positive test from any MOH-accredited lab will be counted, he said.
When the MOH reported the 113 cases last week, it didn't give any of the standard details, such as patient age range, gender balance, and locations. Madani said detailed information has been submitted to the World Health Organization (WHO), and WHO officials said they are now verifying the data with Saudi officials to make sure there is no double counting, according to the story.
Madani also told Reuters he didn't believe the non-reporting had been intentional and said he thought a 20% deficit in reporting of cases is not unusual in a disease outbreak. But others took issue with that view.
Michael T. Osterholm, PhD, MPH, said there is no number that's regarded as normal for the proportion of cases not reported in an outbreak. Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News.
"For serious outbreaks where cases are detected clinically and by labs, there should be complete ascertainment," he told CIDRAP News. If a lab does confirm a case but doesn't report it, "that's a systems failure."
He also noted that a large share of cases can go undetected and unreported if many people have only a mild illness or asymptomatic infections.
Osterholm said he'd like to see more information about all of Saudi Arabia's cases, but he described recent communication developments there as positive: "The information coming from Saudi Arabia right now is still not optimal; we still need more details on when, what, where, and how [patients] became infected. But I think they have a good start on improving on that, and I commend them for it."
Meanwhile, a disclaimer posted today on the MOH's MERS-CoV page hinted that more surprises about case numbers could be on the way. It reads, "The total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance outcome."