Emergencies preparedness, response

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia and Qatar

Disease outbreak news
27 April 2017

Between 18 March and 20 April 2017 the national IHR Focal Point of Saudi Arabia reported 13 additional cases of Middle East Respiratory Syndrome (MERS) including two fatal cases. On 18 April 2017 the national IHR Focal Point of Qatar reported one additional case of MERS.

Details of the cases

Detailed information concerning the cases reported can be found in a separate document (see link below).

Between 18 March and 20 April 2017, 13 cases of MERS were reported in Saudi Arabia. Six of these cases had exposure to infected dromedary camels or consumed their raw milk, which is the most likely source of their infection and two cases were detected through contact tracing of previously reported MERS-CoV cases. Investigation into the history of exposure to the known risk factors in the 14 days prior to onset of symptoms is ongoing for the remaining cases. Contact tracing of household and healthcare contacts is ongoing for all 13 cases.

On 18 April 2017, one case of MERS was reported in Qatar. The 25-year-old case has a history of frequent contact with dromedary camels and no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. He is currently in stable condition admitted to a negative pressure isolation room on a ward. The department of health protection and communicable disease control in the Ministry of Public Health has carried out case investigation and contact tracing. All contacts have tested negative but will continue to be monitored until the end of the monitoring period of 14 days of last exposure to the case.

To date, Qatar has reported 20 laboratory-confirmed cases of MERS. The last case was reported on 21 March 2017 (see Disease Outbreak News published on 4 April 2017).

Globally, since September 2012, WHO has been notified of 1952 laboratory-confirmed cases of infection with MERS-CoV including at least 693 related deaths have been reported.

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.

WHO advice

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 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.