Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia, United Arab Emirates, and Qatar
Between 21 April and 29 May 2017, the National IHR Focal Point of Saudi Arabia reported 25 additional cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection including six fatal cases. On 16 May 2017, the IHR NFP of the United Arab Emirates reported two (2) additional case of MERS-CoV. On 23 May 2017, the National IHR Focal Point of Qatar reported one additional case of MERS-CoV.
Details of the cases
Detailed information concerning the cases reported can be found in a separate document (see link below).
Between 21 April and 29 May 2017, 25 cases of MERS-CoV infection were reported in Saudi Arabia including six fatal cases. Twelve of the 25 reported cases during this time period were associated with three simultaneous, yet unrelated clusters of MERS cases. The Ministry of Health is evaluating each case and their contacts and implementing measures to limit further human-to-human transmission. A description of the three clusters is below.
A cluster of cases has been identified at a hospital in Bisha city, Assir Region. Cases associated with this cluster are:
- First identified fatal case: A 71-year-old male reported on 9 May.
- Secondary case - Healthcare contact: A 54-year-old male reported to WHO on 13 May.
- Secondary case - Healthcare contact: A 57-year-old male reported to WHO on 17 May.
A cluster of cases has been identified in a hospital in Riyadh city, Riyadh Region. Cases associated with this cluster are:
- First identified fatal case: A 55-year-old male reported to WHO on 14 May.
- Secondary case - Healthcare contact: A 33-year-old male reported to WHO on 15 May.
- Secondary case - Healthcare contact: A 30-year-old female reported to WHO on 15 May.
- Secondary case - Healthcare contact: A 25-year-old female reported to WHO on 16 May.
- Secondary case - Healthcare contact: A 38-year-old male reported to WHO on 17 May.
A third cluster was detected at a hospital in Wadi Aldwaser city, Riyadh Region. This outbreak is believed to be over based on the follow-up period of all contacts. The four newly identified cases associated with this outbreak are listed below. In total, five cases were associated with this outbreak: First identified case: A 55-year-old male previously reported to WHO on 19 April (see Disease Outbreak News published on 27 April 2017).
- Secondary case - Household contact: A 50-year-old male reported to WHO on 21 April.
- Secondary case - Household contact: A 58-year-old male reported to WHO on 21 April.
- Secondary case - Healthcare contact: A 31-year-old male reported to WHO on 21 April.
- Secondary case - Household contact: A 26-year-old male reported to WHO on 26 April.
United Arab Emirates
On 16 May 2017, two cases of MERS-CoV infection were reported in the United Arab Emirates. Both cases were reported from Al Ain city and both have reported direct links to dromedary camels. The first case that was identified, a 69-year-old male farmer, is in critical condition in hospital and the second case, a 45-year-old male butcher, is asymptomatic and identified during contact tracing of the first case. Contact tracing and dromedary investigations are ongoing.
On 23 May 2017, one case of MERS-CoV infection was reported in Qatar. The case, a 29 year old male from Doha has reported frequent contact with dromedary camels. The Department of Health Protection and Communicable Disease Control in the Ministry of Public Health and animal health resources are currently carrying out case investigation and contact tracing.
Globally, since September 2012, WHO has been notified of 1980 laboratory-confirmed cases of infection with MERS-CoV including at least 699 related deaths have been reported.
WHO risk assessment
MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in health care settings.
The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, these people should avoid close contact with animals, particularly dromedary camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.