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MERS-CoV Infection in the Arabian Peninsula (Update)

14 May 2014

The sharp rise in the number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases first reported in April 2014, is ongoing. As of 6 May 2014, 495 cases of MERS-CoV have been reported globally, including 141 deaths.

On 12 May, Public Health England was notified of a case of MERS-CoV in a person flying from Jeddah to the US, transiting through London on 1 May 2014. The passenger was on Saudi Airlines flight 113 from Jeddah to London, and transferred at Heathrow for onward travel to the US. This is the second report of MERS-CoV in an American who is a healthcare worker in Saudi Arabia. 

On Friday 2 May 2014, the Centers for Disease Control and Prevention announced the first imported case of MERS-CoV in the US. The case (now recovered) is an American male who was in Saudi Arabia as a healthcare worker. The two cases are not linked.

Further imported cases of MERS-CoV are likely as a result of air travel; there is a theoretical risk of transmission in the cabin of a plane, however, no cases are known to have been spread this way.

There is concern over hospital-based transmission in Saudi Arabia and the United Arab Emirates (UAE): 128 laboratory-confirmed cases who had symptom onset between 17 February and 26 April 2014, and who were treated in 14 hospitals in Jeddah were analysed by WHO mission. More than 60% of the 128 cases are presumed to have acquired infection in a hospital setting, including 39 health care workers.

More than two thirds of 37 recent cases in UAE were in healthcare workers. 

 (Via CDC Press Release - accessed 14/05/14)

(Via ECDC News - accessed 14/05/14)

Advice for Travellers

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.
  • Avoiding contact with camels, consuming raw camel milk or camel products, eating undercooked camel meat.
  • 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.

Advice for Healthcare Professionals

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.