Emergencies preparedness, response

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

Disease outbreak news
16 May 2016

Between 30 April and 5 May 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East Respiratory Syndrome (MERS-CoV), including one fatal case.

Details of the cases

  • A 39-year-old, non-national, male living in Riyadh city is a household contact of another MERS-CoV (see case no. 2 below). He is asymptomatic and identified through tracing of contacts. The patient, who has no comorbid conditions, tested positive for MERS-CoV on 5 May. The patient is currently in home isolation.
  • A 40-year-old, non-national, male living in Riyadh city developed symptoms on 14 April and was admitted to hospital on 1 May. On 2 May, the patient, who has comorbidities, tested positive for MERS-CoV. Investigation of history of exposure to the known risk factors in the 14 days prior to symptom onset is ongoing. Currently the patient is in critical condition admitted to ICU, but not on mechanical ventilation.
  • A 55-year-old, national male living in Hofuf city developed symptoms on 26 April and was admitted to hospital on 29 April. The patient, who had comorbidities, tested positive for MERS-CoV on 30 April. He passed away on 4 May. He had history of frequent contact with dromedaries and consumption of their raw milk. The Ministry of Agriculture was notified and investigation of dromedaries is ongoing.
  • A 70-year-old, national, male living in Hail city developed symptoms on 26 April and was admitted to hospital on 28 April. The patient, who has comorbidities, tested positive for MERS-CoV on 30 April. Investigation of history of exposure to the known risk factors in the 14 days prior to symptom onset is ongoing. Currently the patient is in critical condition admitted to ICU on mechanical ventilation.

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 14 April (case no. 1 and 5) and on 22 April (case no. 2).

Globally, since September 2012, WHO has been notified of 1,733 laboratory-confirmed cases of infection with MERS-CoV, including at least 628 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.