Emergencies preparedness, response

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

Disease outbreak news
6 July 2016

Between 21 June and 30 June 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 13 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

  • A 38-year-old, non-national male from Al Aqiq city developed symptoms on 23 June and was admitted to a hospital on 27 June. The patient, who had no comorbidities, tested positive for MERS-CoV on 29 June. He passed away on 30 June. 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 Dammam city developed symptoms on 17 June and was admitted to a hospital on 27 June. The patient, who has comorbidities, tested positive for MERS-CoV on 28 June. Currently he is in critical condition admitted to ICU. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 27-year-old female from Riyadh city was identified through the tracing of contacts while still asymptomatic. The patient works as healthcare worker in the hospital where a MERS-CoV outbreak is currently occurring (see DON published on 22 June). The patient has no history of exposure to the other known risk factors in the 14 days prior to the detection. She tested positive for MERS-CoV on 29 June. Currently she is in stable condition in home isolation.
  • A 58-year-old, non-national, female healthcare worker from Riyadh city was identified through the tracing of contacts while still asymptomatic. The patient has a history of exposure to a laboratory-confirmed MERS-CoV case (see below – case no. 9). She has no history of exposure to the other known risk factors in the 14 days prior to the detection. The patient tested positive for MERS-CoV on 27 June. Currently she is in stable condition in home isolation.
  • A 75-year-old male from Al Aflaj city developed symptoms on 24 June and was admitted to a hospital on 26 June. The patient, who has comorbidities, tested positive for MERS-CoV on 28 June. He has a history of frequent contact with camels and consumption of their raw milk. The patient 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 on a ward.
  • An 84-year-old male from Hofuf city developed symptoms on 22 June and was admitted to a hospital in Al Hassa on 27 June. The patient, who has comorbidities, tested positive for MERS-CoV on 28 June. Investigation of history of exposure to any of the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 62-year-old male from Riyadh city was identified through the tracing of contacts while still asymptomatic. The patient has a history of exposure to a laboratory-confirmed MERS-CoV case (see below – case no. 10). He has no history of exposure to the other known risk factors in the 14 days prior to the detection. The patient tested positive for MERS-CoV on 24 June. Currently he is still asymptomatic in home isolation.
  • A 28-year-old male healthcare worker from Najran city developed symptoms on 24 June and was admitted to a hospital on the same day. The patient, who has no comorbidities, tested positive for MERS-CoV on 25 June. He has a history of exposure to a laboratory-confirmed MERS-CoV case (see DON published on 22 June – case no. 6). The patient has no history of exposure to the other known risk factors in the 14 days prior to the detection. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward.
  • A 33-year-old, non-national female from Riyadh city was identified through the tracing of contacts while still asymptomatic. The patient, who has no comorbidities, works as healthcare worker in the hospital where a MERS-CoV outbreak is currently occurring (see DON published on 22 June). The patient has no history of exposure to the other known risk factors in the 14 days prior to the detection. She tested positive for MERS-CoV on 24 June. Currently she is in stable condition in home isolation.
  • A 25-year-old female from Riyadh city was identified through the tracing of contacts while still asymptomatic. The patient, who has no comorbidities, was admitted to the hospital where a MERS-CoV outbreak is currently occurring (see DON published on 22 June). She has no history of exposure to the other known risk factors in the 14 days prior to the detection. Investigation of possible epidemiological links with MERS-CoV cases detected in the same hospital is ongoing. She tested positive for MERS-CoV on 23 June. Currently she is asymptomatic in home isolation.
  • A 55-year-old, non-national male from Jeddah city developed symptoms on 14 June and was admitted to hospital on 21 June. The patient, who has no comorbidities, tested positive for MERS-CoV on 22 June. Investigation of history of exposure to any of the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in stable condition in a negative pressure isolation room on a ward.
  • A 57-year-old female from Jeddah city developed symptoms on 18 June and was admitted to a hospital on the same day. The patient, who has comorbidities, tested positive for MERS-CoV on 21 June. She has a history of exposure to a laboratory-confirmed MERS-CoV case (see below – case no. 13). The patient has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. Currently she is in stable condition in home isolation.
  • A 66-year-old male from Jeddah city developed symptoms on 16 June and was admitted to a hospital on 17 June. The patient, who has comorbidities, tested positive for MERS-CoV on 19 June. Investigation of history of exposure to any of the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition in ICU.

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 case that were reported in previous DONs on 21 June (case no. 6) and 19 June (case no. 2 and 6).

Globally, since September 2012, WHO has been notified of 1,782 laboratory-confirmed cases of infection with MERS-CoV, including at least 634 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.