Emergencies preparedness, response

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News

The Ministries of Health of Saudi Arabia and the United Arab Emirates (UAE) recently announced additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The 4 additional laboratory-confirmed cases reported to WHO by the Ministry of Health of Saudi Arabia on 28 March and 2 April 2014 include:

  • A 26 year-old man from Jeddah. He became ill on 22 March, was hospitalised on 23 March, and died on 6 April.
  • A 26 year-old man from Jeddah. He became ill on 16 March and has been hospitalised since 25 March.
  • A 77 year-old woman from Riyadh region. She became ill on 25 March and is currently in a stable condition. She is not known to have a history of exposure to animals.
  • A 59 year-old man from Riyadh region who became ill on 22 March, 2014. He is not known to have contact with animals or a known case.

The additional laboratory-confirmed case reported to WHO by the Ministry of Health of the UAE on 30 March includes:

  • A 64 year-old man from Abu Dhabi with underlying medical conditions. He became ill on 21 March, was hospitalised on 25 March and died on 30 March. He had underlying medical conditions. He did not have contact with a previously laboratory-confirmed case, but has had exposure to animals. The patient visited a camel farm in Harb city in Saudi Arabia on 10 March and visited Nezwa city in Oman for a day on 20 March. He owned an animal farm in the UAE with poultry and sheep, but had no recent visit to the farm. Investigation into the family and health care contacts is ongoing.

Globally, from September 2012 to date, WHO has been informed of a total of 211 laboratory-confirmed cases of infection with MERS-CoV, including 88 deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) 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. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all 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.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.