Emergencies preparedness, response

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
14 March 2016

Between 26 February and 08 March 2016 the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 25 additional cases of Middle East respiratory syndrome coronavirus infection (MERS-CoV), including 4 fatal cases.

Details of the cases

  • A 24-year-old, non-national male from Buraidah city developed symptoms on 19 February and, on the same day, was admitted to the hospital where the current MERS-CoV outbreak is occurring. While hospitalized, he developed further symptoms on 5 March. The patient, who has no comorbidities, tested positive for MERS-CoV on 7 March. Currently, he is in critical condition in ICU. Investigation of epidemiological link with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 56-year-old, non-national male from Buraidah city developed symptoms on 6 February and, on the same day, was admitted to the hospital where the current MERS-CoV outbreak is occurring. While hospitalized, the patient developed further symptoms on 7 March. He was admitted to ICU and passed away on the same day. The patient, who had comorbidities, tested positive for MERS-CoV on 8 March. Investigation of epidemiological links with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 68-year-old female from Buraidah city developed symptoms on 2 March and, on 5 March, was admitted to the hospital where the current MERS-CoV outbreak is occurring. The patient, who has comorbidities, tested positive for MERS-CoV on 7 March. Currently, the patient is in stable condition in a negative pressure isolation room. Investigation of exposure to the known risk factor in the 14 days prior to the onset of symptoms is ongoing.
  • A 41-year-old male from Alzulfi city developed symptoms on 25 February and, on 4 March, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 6 March. Currently, he is in stable condition in a negative pressure isolation room. Investigation of exposure to the known risk factor in the 14 days prior to the onset of symptoms is ongoing.
  • An 81-year-old male from Buraidah city was first admitted to the hospital where the current MERS-CoV outbreak is occurring, between 5 and 28 February. After discharge, he developed further symptoms on 1 March and was readmitted to the same hospital on 4 March. The patient, who has comorbidities, tested positive for MERS-CoV on 6 March. Currently, he is in critical condition in ICU. Investigation of epidemiological links with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 42-year-old male from Buraidah city developed symptoms on 26 February and, on 4 March, was admitted to the hospital where the current MERS outbreak is occurring. The patient, who has no comorbidities, tested positive for MERS-CoV on 6 March. Currently, the patient is in stable condition in a negative pressure isolation room. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 36-year-old, non-national male from Buraidah city (working at the hospital where the current MERS-CoV outbreak is occurring) developed symptoms on 28 February and, on 4 March, was admitted to the same hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 6 March. Currently, he is in stable condition in a negative pressure isolation room. Investigation of epidemiological links with MERS-CoV cases admitted to this hospital is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 68-year-old male from Alrass city developed symptoms on 3 March and, on 5 March, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 7 March. Currently, he is in stable condition in a negative pressure isolation room. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 76-year-old male from Buraidah city was admitted to the hospital where the current MERS-CoV outbreak is occurring on 4 February, due to his chronic comorbid conditions. While hospitalized, he developed further symptoms on 3 March. The patient tested positive for MERS-CoV on 5 March. Currently, he is in stable condition in a negative pressure isolation room. Investigation of epidemiological links with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 62-year-old, non-national male from Buraidah city, working as a physician in the hospital where the current MERS-CoV outbreak is occurring, developed symptoms on 3 March and, on 4 March, was admitted to the same hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 5 March. Currently, he is in stable condition in a negative pressure isolation room. Investigation of epidemiological links with MERS-CoV cases hospitalized in this hospital is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 49-year-old male from Riyadh city developed symptoms on 1 March and, on 5 March, was admitted to the hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 6 March. Currently, he is in stable condition in a negative pressure isolation room. The patient has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 70-year-old male from Buraidah city developed symptoms on 10 February and, on 17 February, was admitted to the hospital where the current MERS outbreak is occurring. The patient, who has comorbidities, first tested negative for MERS-CoV on 20 February, but later tested positive on 4 March after worsening of symptoms. Currently, he is in stable condition in a negative pressure isolation room. Investigation of epidemiological links with MERS-CoV cases hospitalized in this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 82-year-old male from Hail city developed symptoms on 10 February and, on 22 February, was admitted to the hospital where the current MERS outbreak is occurring. The patient, who has comorbidities, first tested negative for MERS-CoV on 24 February, but later tested positive on 4 March after worsening of symptoms. Currently, he is in critical condition in ICU. Investigation of epidemiological link with MERS-CoV cases hospitalized in this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 23-year-old male from Buraidah city was admitted to the hospital where the current MERS outbreak is occurring on 15 February, due to a chronic comorbid condition. On 2 March, while hospitalized, he developed further symptoms, and tested positive for MERS-CoV on 4 March. Currently, the patient is in critical condition in ICU, but not on mechanical ventilation. Investigation of epidemiological link with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 49-year-old male from Jeddah city, working as a physician in a hospital, developed symptoms on 26 February and, on 2 March, was admitted to the same hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 4 March. Currently, he is in stable condition in a negative pressure isolation room. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 67-year-old female from Buraidah city developed symptoms on 28 February and, on 1 March, was admitted to the hospital where the current MERS outbreak is occurring. The patient, who had comorbidities, tested positive for MERS-CoV on 3 March. She was in critical condition in ICU but not on mechanical ventilation, and passed away on 6 March. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 52-year-old female from Riyadh city developed symptoms on 22 February and, on 25 February, was admitted to hospital. The patient, who has comorbidities, first tested negative for MERS-COV on 27 February, but later tested positive on 3 March after worsening of symptoms. Currently, she is in critical condition in ICU but not on mechanical ventilation. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 40-year-old male from Buraidah city first developed symptoms on 22 February and, on the same day was admitted to the hospital where the current MERS outbreak is occurring. While hospitalized, he developed further symptoms on 28 February. The patient, who had comorbidities, tested positive for MERS-CoV on 1 March. He was in critical condition in ICU, and passed away on 4 March. Investigation of epidemiological link with MERS-CoV cases admitted to this hospital or with shared health care workers is ongoing. The case had no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
  • A 30-year-old, non-national male from Riyadh city developed symptoms on 26 February and, on 27 February, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 28 February. The patient has a history of contact with two MERS-CoV cases (see DON published on 10 March – case no. 6, and case no. 22 below). He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in stable condition in a negative pressure isolation room.
  • A 68-year-old male from Shaqra city developed symptoms on 15 February and, on 25 February, was admitted to the hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 27 and 28 February (a second sample was tested for further confirmation). Currently, he is in stable condition in a negative pressure isolation room. He has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 72-year-old male from Al Artawiyah city developed symptoms on 23 February and, on 27 February, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 28 February. Currently, he is in stable condition in a negative pressure isolation room. He has a history of frequent contact with camels and consumption of their raw milk. He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 30-year-old, non-national male from Riyadh city developed symptoms on 19 February and, on 20 February, was admitted to hospital. The patient, who has comorbidities, first tested negative for MERS-CoV on 21 and 24 February, but after worsening of symptoms, tested positive on 27 February. The patient has a history of contact with a MERS-CoV case (see DON published on 10 March – case no. 6 ). He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
  • A 50-year-old male from Muhayil city developed symptoms on 19 February and, on 25 February, was admitted to hospital. The patient, who had comorbidities, tested positive for MERS-CoV on 27 February. The patient was in critical condition in ICU, and passed away on 26 February. He had a history of frequent contact with camels and consumption of their raw milk. He had no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. The Ministry of Agriculture was notified and is now conducting investigations.
  • A 68-year-old male from Riyadh city developed symptoms on 15 February and, on 23 February, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 25 February. Currently, he is in stable condition in a negative pressure isolation room. Investigation of history of exposure to any of the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 72-year-old male from Arruwaidhah city developed symptoms on 17 February and, on 23 February, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 25 February. Currently, he is in critical condition in ICU, but not on mechanical ventilation. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 MERS-CoV cases that were reported in a previous DON on 10 March (case no. 2 and 6).

Globally, since September 2012, WHO has been notified of 1,677 laboratory-confirmed cases of infection with MERS-CoV, including at least 597 related deaths.

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.

WHO advice

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 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.

Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

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