Emergencies preparedness, response

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

Disease Outbreak News

On 18 April 2014, the Ministry of Health of Greece reported 1 laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO by the Ministry of Health, Greece, on 18 April 2014:

The patient is a 69 year-old male Greek citizen residing in Jeddah, Saudi Arabia, who travelled back to Greece on 17 April. While in Jeddah, the patient consulted a hospital on 8 and 10 April for a febrile illness with diarrhoea, and was given a probable diagnosis of typhoid fever. Of note, he regularly visited his wife who was hospitalised from 31 March to 5 April in the same hospital for a confirmed typhoid fever.

The patient sought medical care upon arrival in Greece on 17 April. The evaluation revealed a bilateral pneumonia and the diagnosis of MERS-CoV infection was made at the National Reference Laboratory for Influenza. The patient is in stable condition and is receiving appropriate treatment.

This is the first case of MERS-CoV infection in the country.

Individuals who had close contacts with the case in the plane, the hospital in Greece and in the community have been identified and are being followed up. So far, none of the contacts became ill. Hellenic health authorities issued a press release to inform the population and informed all Greek hospitals on measures that need be taken to identify suspect patients and implement appropriate preventive measures.

Globally, from September 2012 to date, WHO has been informed of a total of 250 laboratory-confirmed cases of infection with MERS-CoV, including 93 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.