International travel and health

Middle East - Novel Coronavirus (nCoV)

20 May 2013 - Since September 2012, 44 cases of novel coronavirus (nCoV) infection have been identified in a number of countries in the Middle East. More recently, the infection has been diagnosed in a traveller returning from the region. The most common symptoms observed are fever, cough, shortness of breath and breathing difficulties while atypical symptoms such as diarrhoea have also been seen in patients with immunosuppression. Currently, the source of the virus is unknown; the virus is thought to be of animal origin but so far it has not been identified in any animal species. The specific types of exposures that result in infection are also unknown. While the virus has been shown to transmit between humans who are in close contact, transmission has not been sustained beyond these cases or extended from these cases into the community.

Although the infection does not seem to transmit easily, travellers to the Middle East who develop symptoms either during their travel or after their return are encouraged to seek medical attention and to share their history of travel. People with symptoms of acute respiratory infection should be encouraged to 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.

While the mechanism of viral transmission is still unknown, it would be prudent to try to reduce the risk of infection while travelling by: avoiding close contact with people suffering from acute respiratory infections; frequent hand-washing, especially after direct contact with ill people or their environment; adhering to food safety and hygiene rules; and avoiding close contact with farm/wild animals.

Health care practitioners should consider the possibility of nCoV infection in symptomatic travellers with a recent history of travel in the Middle East and should apply infection prevention and control measures recommended by WHO or outlined in national guidance. nCoV infection generally presents as pneumonia, but has also caused kidney failure. When a patient presents with fever, cough, shortness of breath and breathing difficulties or other symptoms suggesting an infection, health care workers should take a travel history to find out if that person has been in areas where nCoV has been recorded. If a diagnosis of nCoV is considered possible, the patient should be referred to a special infectious disease unit for further investigation.

Based on the information available, WHO advises against any travel or trade restrictions or special screening of travellers at points of entry.