Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
Between 19 and 23 April 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 3 additional cases of Middle East Respiratory Syndrome (MERS-CoV).
Details of the cases
- A 58-year-old female from Abha city developed symptoms on 16 April and was admitted to a hospital on the same day. She first tested negative for MERS-CoV on 20 April, but later tested positive on 22 April. The patient has comorbidities and is a household contact of a case reported in a previous DON on 22 April (case no. 7). She has no history of exposure to other known risk factors in the 14 days prior to onset of symptoms. Currently the patient is in critical condition admitted to ICU, but not on mechanical ventilation.
- A 31-year-old male from Riyadh city developed symptoms on 15 April. He is a health care worker in a hospital and was admitted to the same hospital on 16 April. He tested positive for MERS-CoV on 18 April. The patient has no comorbid conditions. He has a history of caring for a case reported in a previous DON on 22 April (case no. 2). He has no history of exposure to other known risk factors in the 14 days prior to onset of symptoms. Currently the patient is in stable condition in home isolation.
- A 24-year-old male from Hofuf city was identified as a household contact of a case reported in a previous DON on 22 April (case no. 5). He is asymptomatic and was identified during contact tracing. He tested positive for MERS-CoV on 18 April. The patient has no comorbid conditions. He has a history of frequent contact with the same dromedaries and consumption of their raw milk. Currently, the patient is asymptomatic and in home isolation.
Contact tracing of household and healthcare contacts is ongoing for these cases.
Globally, since September 2012, WHO has been notified of 1,728 laboratory-confirmed cases of infection with MERS-CoV, including at least 624 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.
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.
* Please note that the total number of deaths stated above has been corrected from 623 (initially posted on 26 April 2016) to 624 (corrected on 27 April 2016).