Middle East respiratory syndrome coronavirus (MERS-CoV) – The United Arab Emirates
On 7 October 2019, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.
The patient is a 44-year-old male non-national farmer from Al Ain city, Abu Dhabi region, UAE. He developed fever, runny nose, headache, vomiting, productive cough and shortness of breath on 25 September 2019, and was admitted to hospital on 29 September. A nasopharyngeal aspirate was collected and tested positive for MERS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) on 3 October at the Shiekh Khalifa Medical Center laboratory. The patient has underlying comorbidities including diabetes mellitus, hypertension and hyperlipidemia. He has a history of close contact with dromedary camels and sheep at nearby farms during the 14 days prior to the onset of symptoms. He has no history of recent travel and has not been involved in the slaughtering of animals. As of 14 October, the patient is in stable condition and is currently in an intensive care unit (ICU).
This is the first case of MERS-CoV infection reported from UAE since May 2018. Since 2012, UAE has reported 88 cases (including the patient reported above) of MERS-CoV infection and 12 associated deaths.
Globally, from 2012 through 8 October 2019, a total of 2,470 laboratory-confirmed cases of infection with MERS-CoV have been reported to WHO, including 851 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under the International Health Regulations (IHR 2005) to date. The total number of deaths includes the deaths reported to WHO and through follow-up with Ministries of Health in affected member states.
Public health response
Upon identification of the patient, an incident report, case investigation and contact tracing were initiated. The investigation is ongoing and includes screening of household and occupational contacts in the farm where the patient works and of healthcare workers at the hospital where he is receiving treatment.
To date, a total of 61 contacts including 57 health care workers and 4 farm co-workers living in the same household have been identified. All identified contacts of the patient are being monitored daily for the appearance of respiratory or gastrointestinal symptoms for a period of 14 days following their last exposure to the patient. Out of the 57 health care contacts, five were restricted from work after developing respiratory symptoms. All contacts were tested for MERS-CoV and tests results were negative.
Veterinary authorities have been notified and investigations for MERS-CoV in animals are ongoing.
WHO risk assessment
Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained 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 dromedary camels, animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting or household contacts).
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 infection early because like other respiratory infections, the early symptoms of MERS-CoV infection are non-specific. Therefore, healthcare workers should 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.
Early identification, case management and isolation, together with appropriate infection prevention and control measures can prevent human-to-human transmission of MERS-CoV.
MERS-CoV causes more severe disease in people with underlying chronic medical conditions such as diabetes mellitus, renal failure, chronic lung disease, and compromised immune systems. Therefore, people with these underlying medical conditions should avoid close unprotected contact with animals, particularly dromedary 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.
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.