Emergencies preparedness, response

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

Disease outbreak news
3 July 2015

Between 19 and 30 June 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 6 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

Details of the cases are as follows:

  • A 65-year-old female from Riyadh city developed symptoms on 15 June and was admitted to hospital on 25 June. The patient, who has comorbidities, tested positive for MERS-CoV on 27 June. Currently, she is in critical condition in ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 40-year-old male from Riyadh city developed symptoms on 24 June and was admitted to hospital on 26 June. The patient, who has comorbidities, tested positive for MERS-CoV on 27 June. Currently, he is in critical condition in ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 41-year-old male from Hofuf city developed symptoms on 19 June and tested positive for MERS-CoV on 21 June. He is a family relative of a laboratory-confirmed MERS-CoV case that worked in a hospital with an ongoing MERS-CoV outbreak and that was reported in a previous DON on 23 June (case n. 1). The patient, who has comorbidities, was in home isolation; however, as symptoms worsened, he was admitted to hospital on 23 June. The patient has no history of exposure to other known risk factors in the 14 days prior to onset of symptoms. Currently, he is in stable condition in a negative pressure isolation room on a ward.
  • A 60-year-old, non-national, female health care worker from Hofuf city developed symptoms on 14 June, was admitted to hospital on 15 June and tested positive for MERS-CoV on 19 June. The patient, who has comorbidities, works in a hospital that has been experiencing a MERS-CoV outbreak. Currently, the patient is in stable condition in a negative pressure isolation room on a ward. Investigation of possible links with MERS-CoV cases admitted to this hospital is ongoing.
  • A 61-year-old female from Hofuf city developed symptoms on 30 May and, on the same day, was admitted to a hospital with an ongoing MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 17 June. Currently, she is in critical condition admitted to ICU. Investigation of possible links with MERS-CoV cases admitted to the hospital is ongoing. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is also ongoing.
  • A 52-year-old male from Hofuf city developed symptoms on 16 June while admitted to hospital for an unrelated medical condition since 29 April. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 18 June. Currently, the patient is in stable condition in a negative pressure isolation room on a ward. Investigation of possible links with MERS-CoV cases admitted to the hospital 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 a MERS-CoV case that was reported in a previous DON on 23 June (case n. 3).

Globally, since September 2012, WHO has been notified of 1,363 laboratory-confirmed cases of infection with MERS-CoV, including at least 487 related deaths.

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.

WHO remains vigilant and is monitoring the situation. 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.

Public health authorities in host countries preparing for mass gatherings should ensure that all recommendations and guidance issued by WHO with respect to MERS-CoV have been appropriately taken into consideration and made accessible to all concerned officials. Public health authorities should plan for surge capacity to ensure that visitors during the mass gathering can be accommodated by health systems.