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The European Centre for Disease Prevention and Control (ECDC) has highlighted the marked and sudden increase in the number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases being reported in April 2014. The majority of cases continue to be in Saudi Arabia and the Arabian Peninsula, however, earlier this month a confirmed case in Greece in a traveller from Saudi Arabia, raised the number of EU affected countries to five i.e.France, Germany, Italy and the UK. It is thought likely that more cases will be imported to the EU.
The cause of the rapid increase in cases is not known. Possible scenarios include:
As of 23 April 2014, 345 laboratory-confirmed cases of MERS-CoV and 107 deaths have been reported worldwide. Cases have been identified in 14 countries, of those, four have reported one case, whilst 272 cases have been in Saudi Arabia. Of the 345 cases, 72 have been healthcare workers.
(Via ECDC News 25/04/14 - accessed 30/04/14)
The current Rapid Risk Assessment by ECDC is unchanged in that, the risk of MERS-CoV infection for Europeans visiting or residing in the region is low, and secondary transmission in the EU from imported cases is low.
Although the source of the virus and the mechanism of transmission is unknown, it would be sensible to try to reduce the general risk of infection while travelling by:
• Avoiding close contact with people suffering from acute respiratory infections.
• Frequent handwashing, especially after direct contact with ill people or their environment.
• Adhering to food safety and hygiene rules such as avoiding undercooked meats, raw fruits and vegetables unless they have been peeled, or unsafe water.
• 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 should be adhered to.
• People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands) and to delay travel until they are no longer symptomatic.
Travellers to the Middle East who develop symptoms either during travel or after their return are encouraged to seek medical attention and to share their history of travel.
Consider the possibility of MERS-CoV infection in travellers with fever, cough, shortness of breath, or breathing difficulties, or other symptoms suggesting an infection, and with a recent history (within 14 days) of travel in the Middle East.
If a diagnosis of MERS–CoV infection is considered possible, apply infection prevention and control measures recommended by WHO, or outlined in national guidance, and refer the patient to a special infectious disease unit for further investigation.
