Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
Between 15 and 16 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, including 1 death. 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 54-year-old, non-national male from Buraidah city developed symptoms on 4 March and, on 9 March, was admitted to the hospital where the MERS-CoV outbreak is currently occurring. Prior to symptom onset, the patient regularly visited the same health care facility for an unrelated medical condition. On 14 March, the patient, who has comorbidities, tested positive for MERS-CoV. Currently, he is in critical condition in ICU. Investigation of epidemiological link with MERS-CoV cases admitted to the same hospital or with shared healthcare workers is ongoing. The case has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
- An 84-year-old male from Buraidah city developed symptoms on 2 March and, on 9 March, was admitted to hospital. The patient, who had comorbidities, tested positive for MERS-CoV on 11 March. He passed away on 14 March. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 45-year-old male from Riyadh city developed symptoms on 29 February and, on 13 February, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 14 March. Currently, the patient is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 78-year-old female from Alkharj city developed symptoms on 10 March and, on 13 March, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 14 March. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient has a history of frequent consumption of raw camel milk.
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 3 MERS-CoV cases that were reported in previous DONs on 21 March (case no. 3 and 4) and on 18 March (case no. 2).
Globally, since September 2012, WHO has been notified of 1,698 laboratory-confirmed cases of infection with MERS-CoV, including at least 609 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.