Global Alert and Response (GAR)

Middle East respiratory syndrome coronavirus (MERS-CoV) – update

Disease Outbreak News

On 17 April 2014, the Ministries of Health of Malaysia and the United Arab Emirates (UAE) reported an additional 5 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The following details were provided to WHO by the Ministry of Health, Malaysia on 17 April 2014:

  • The patient is a 54 year-old man with underlying health conditions. He travelled to Jeddah, Saudi Arabia with a pilgrimage group of 18 people from 15 to 28 March 2014 and became ill on 4 April. He sought treatment in a private clinic in Johor, Malaysia on 7 April and went to a hospital on 9 April. The patient died on 13 April. The patient visited a camel farm on 26 March, during which he consumed camel milk.

This is the first case with MERS-CoV infection in the country. The Ministry of Health reported that so far no human-to-human transmission has been observed amongst close contacts and in health-care facilities in Malaysia.

The following details were provided to WHO by the Ministry of Health, UAE on 17 April 2014:

A cluster of four health-care workers were identified through screening of contacts of a previously laboratory-confirmed case from Abu Dhabi who died on 10 April 2014. These include:

  • A 44 year-old man from Abu Dhabi who was screened on 13 April. He had no illness and is reported to have no underlying medical condition.
  • A 30 year-old man from Abu Dhabi who was screened on 13 April. He had no illness and is reported to have no underlying medical condition.
  • A 34 year-old man from the Philippines who resides in Abu Dhabi. He was screened on 13 April without any illness and is reported not to have any underlying medical condition.
  • A 28 year-old man from Abu Dhabi who became ill on 14 April 2014. He is reported to have no underlying medical condition.

All the above mentioned cases are known to have exposure to a previously laboratory-confirmed case. They have no reported history of recent travel and no contact with animals. Three cases are in isolation in a hospital and are in a stable condition. One case returned to his home country although he was advised not to before the laboratory results were received. Screening of other health care contacts and of family members is ongoing.

Globally, from September 2012 to date, WHO has been informed of a total of 243 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) 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. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all 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.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

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, and following food hygiene practices, should be adhered to.

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.

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