Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
Between 13 and 14 March 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. One of these reported cases is linked to the MERS-CoV outbreak currently occurring in a hospital in Buraidah city.
Details of the cases
- A 47-year-old male from Taif city developed symptoms on 9 March and, on 10 March, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 11 March. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient has a history of contact with a previously reported MERS-CoV case (see DON published on 16 March – case no. 1). He was under observation and was identified after developing symptoms. The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
- A 45-year-old male from Alkharj city developed symptoms on 11 March and, on 13 March, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 14 March. Currently, he is in critical condition in ICU. 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 investigation of camels is ongoing.
- A 60-year-old male from Hail city developed fever, nausea, and shortness of breath on 5 March and, on 10 March, was admitted to the hospital in Buraidah where the MERS outbreak is currently occurring. The patient, who has comorbidities, tested positive for MERS-CoV on 12 March. Currently, the patient is in critical condition in ICU. Investigation of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 33-year-old, non-national male from Buraidah city developed symptoms on 2 March and, on 10 March, was admitted to the hospital where the MERS outbreak is currently occurring. The patient, who has no comorbidities, tested positive for MERS-CoV on 12 March Currently, he patient is in critical condition in ICU. The patient frequently visited a family member who has been admitted to the same hospital since 23 February due to an unrelated medical condition. Investigation of epidemiological links with MERS-CoV cases admitted to the hospital is ongoing. The patient has no history of exposure to the other risk factors in the 14 days prior to the onset of symptoms.
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 previous DONs on 16 March (case no. 4) and on 14 March (case no. 8).
Globally, since September 2012, WHO has been notified of 1,694 laboratory-confirmed cases of infection with MERS-CoV, including at least 605 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.
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.