Emergencies preparedness, response

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

Disease outbreak news
22 April 2016

Between 1 and 15 April 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 10 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 3 deaths.

Details of the cases

  • A 54-year-old male from Najran city developed symptoms on 3 April and was admitted to a hospital on 12 April. He tested positive for MERS-CoV on 14 April. The patient has comorbidities and a history of frequent contact with dromedaries and consumption of their raw milk. Currently, he is in stable condition in a negative pressure isolation room at the hospital. The Ministry of Agriculture has been informed and investigation is ongoing.
  • A 25-year-old male from Riyadh city was admitted to a hospital on 29 March due to an unrelated medical condition. On 10 April, and while hospitalized, he developed symptoms. The patient tested positive for MERS-CoV on 12 April. He was admitted to ICU with a MERS-CoV case (see below – case no. 9), between 2 and 4 April. He has no history of exposure to the 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 at the hospital.
  • A 73-year-old male from Riyadh city developed symptoms on 9 April and was admitted to a hospital on 11 April. The patient tested positive for MERS-CoV on 12 April. The patient has comorbidities. Investigation of history of exposure to the known risk factors is ongoing. Currently the patient is in critical condition admitted to ICU.
  • A 71-year-old male from Khayber city developed symptoms on 3 April and was admitted to a hospital on 10 April. The patient tested positive for MERS-CoV on 11 April. The patient has comorbidities and a history of frequent contact with dromedaries and consumption of their raw milk. Currently he is in stable condition in a negative pressure isolation room at the hospital. The Ministry of Agriculture has been informed and investigation is ongoing.
  • A 21-year-old male from Hofuf city developed symptoms on 9 April and was admitted to a hospital on the same day. The patient tested positive for MERS-CoV on 10 April. The patient has no comorbidities but has a history of frequent contact with dromedaries and consumption of their raw milk. Currently he is in stable condition in a negative pressure isolation room at the hospital. The Ministry of Agriculture has been informed and investigation is ongoing.
  • A 59-year-old male from Dammam city developed symptoms on 6 April and was admitted to a hospital on 7 April. The patient tested positive for MERS-CoV on 8 April. The patient has comorbidities and a history of frequent contact with dromedaries and consumption of their raw milk. He has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. Currently the patient is in stable condition in home isolation. The Ministry of Agriculture has been informed and investigation is ongoing.
  • A 70-year-old male from Abha city developed symptoms on 2 April and was admitted to a hospital on 5 April. The patient tested positive for MERS-CoV on 6 April. The patient had comorbidities. Investigation of history of exposure to the known risk factor is ongoing. The patient passed away on 6 April.
  • A 53-year-old male from Najran city underwent an elective surgery in a hospital on 18 March. He developed complications and was transferred to a different hospital on 2 April. The patient tested positive for MERS-CoV on 4 April. The patient has comorbidities. Investigation of history of exposure to the known risk factor is ongoing. Currently the patient is in critical condition admitted to ICU on mechanical ventilation.
  • A 74-year-old male from Alkharj city developed symptoms on 20 March and was admitted to a hospital in Riyadh on 24 March. The patient tested positive for MERS-CoV on 4 April. The patient had comorbidities. Investigation of history of exposure to any of the known risk factor is ongoing. The patient passed away on 5 April.
  • A 75-year-old female from Buraidah city was bed ridden for several years. She was admitted to a hospital in Buraidah on 12 March where the MERS-CoV outbreak occurred (see DON published on 14 March) for an unrelated medical condition. On 29 March, and while hospitalized she developed symptoms. The patient tested positive for MERS-CoV on 30 March. She had comorbidities. Investigation of exposure to any MERS-CoV cases hospitalized in the same hospital, shared healthcare workers or other known risk factors in the 14 days prior to the onset of symptoms is ongoing. The patient passed away on 29 March.

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 2 MERS-CoV cases that were reported in a previous DON on 14 April (case no. 8, 10).

Globally, since September 2012, WHO has been notified of 1,724 laboratory-confirmed cases of infection with MERS-CoV, including at least 623 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.