* Revision of numbers raises questions about data collection
* Saudi official says under-reporting not deliberate
* Experts welcome Saudi promises of greater transparency
* MERS virus has killed more than 300 people worldwide
By Kate Kelland, Health and Science Correspondent
LONDON, June 5 A dramatic upward revision in the
number of people killed by the MERS virus in Saudi Arabia may
signal a fresh approach from Riyadh, but also raises new
questions about how the two-year-old outbreak has been handled.
Experts in global health and infectious diseases say
transparency with data is critical to learning more about the
virus, which until two years ago had never been seen in humans
but has now killed more than 300 people worldwide.
And while an announcement on Tuesday that a historical
review of the outbreak had revealed 113 previously unreported
cases, including 92 deaths, suggested greater openness, some
scientists said international health authorities may have been
kept in the dark.
"It really calls into question why these cases weren't
reported before - particularly those that are at least two or
more months back in time," said Michael Osterholm, director of
the Center for Infectious Diseases Research and Policy at the
University of Minnesota.
"From the information we have available I don't think we can
tell why (they weren't reported before). But it's one of two
reasons - one, it was incompetent surveillance that was not
properly set up to be able to detect and confirm these cases, or
two, it was an intentional effort not to report some cases,
particularly the more severely ill and fatal cases."
Tariq Madani, head of the scientific advisory board in the
Saudi Health Ministry's command and control centre, said he did
not believe the under-reporting had been deliberate, and was due
to a range of factors.
"We don't think this was intentionally done, intentionally
under reported. This can happen anywhere in the world, that 20
percent of patients may not be reported. This is within the
limit. It's actually less than 20 percent," he said.
The Middle East Respiratory Syndrome (MERS) virus, which can
cause fever, coughing, shortness of breath and pneumonia, is
thought to be transmitting into humans from camels, although
scientists say human-to-human spread is also taking place.
The Saudi agriculture minister was reported on Thursday as
saying the kingdom's camels would be tested.
Saudi Arabia has already been criticised for its handling of
the outbreak, which public health experts say could have been
under control by now if officials and scientists there had been
more willing to collaborate on studies into how the virus
operates and where it is coming from..
In response, the health ministry says it has put in place
new measures for better data gathering, reporting and
transparency, including standardisation of testing and improved
guidelines for labelling and storing samples.
On Monday, acting health minister Adel Fakieh announced he
had dismissed deputy health minister Ziad Memish from his post.
Fakieh was appointed in April after King Abdullah sacked his
predecessor Abdullah al-Rabeeah following a surge in MERS cases.
On Tuesday the ministry revealed a jump of nearly 50 percent
in MERS deaths in a data review that also showed the number of
cases since 2012 was a fifth higher than previously reported.
Latest Saudi figures show a total of 691 MERS cases in
people there, of which 284 have been fatal.
The European Centre for Disease Prevention and Control
(ECDC) said it was not clear whether the new cases met the World
Health Organisation's definition of confirmed cases and noted
that they had been reported without key details.
"Information about age, gender, residence, probable place of
infection, whether the case is sporadic/primary or part of a
cluster of secondary transmission, health care associated
transmission or not, and whether the case is a healthcare
worker, is missing," the ECDC said.
The health ministry's Madani said that although only limited
data was published on the ministry's website, more detailed data
was available to scientists and healthcare professionals who
contacted the ministry directly.
Ian MacKay, an associate professor of clinical virology at
Australia's University of Queensland who has been tracking the
MERS outbreak since the virus was first identified almost two
years ago, told Reuters he remained sceptical about how
transparent the new officials would be.
"I'm fairly doubtful about the whole process," he said in a
telephone interview. "We're seeing all this under a banner of
increased transparency, and yet there's no information about
what these 113 cases are, about where or how they were tested,
or what age they are. There's really very little information, so
I'm very dubious about what this is supposed to tell us."
The United Nations' public health arm, the World Health
Organisation, said its experts were in Saudi Arabia providing
"The recent appointment of a new Minister of Health has
resulted in renewed energies and greater government commitments
to address the challenges linked to MERS. WHO welcomes all
efforts to gather and verify information and support the sharing
of information about MERS," it said.
Osterholm said international scientists and health
authorities should encourage Saudi Arabia to stick to its word.
"MERS is not a Kingdom of Saudi Arabia problem, and it's not
a Middle East problem, it's an international problem - and it
takes an international response to deal with it," he said,
noting that people infected with the virus have already imported
cases from the region into Europe, Asia and the United States.
"Imagine if tomorrow one of these air passengers turned out
to be a super shedder of the virus and ends up in London or New
York or Hong Kong or Toronto. The world would change overnight."
(Additional reporting by Angus McDowall in Riyadh, editing by