9 May 2014

Middle East respiratory syndrome- coronavirus (MERS CoV)–Multistate (ECDC/CDTR, May 9 2014, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]

COMMUNICABLE DISEASE THREATS REPORT

Week 19, 4-10 May 2014

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

Opening date: 24 September 2012 Latest update: 8 May 2014

 

Epidemiological summary

Summary:

Since April 2012 and as of 8 May 2014, 537 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 148 deaths.

Of the 536 cases, 96 (18%) were healthcare workers.

The following countries have reported MERS-CoV cases:

  • Middle East:
    • Saudi Arabia: 446 cases / 120 deaths
    • United Arab Emirates: 53 cases / 9 deaths
    • Qatar: 7 cases / 4 deaths
    • Jordan: 8 cases / 4 deaths
    • Oman: 2 cases / 2 deaths
    • Kuwait: 3 cases / 1 death
    • Egypt: 1 case / 0 deaths
    • Yemen: 1 case /1 death
  • Europe:
    • UK: 4 cases / 3 deaths
    • Germany: 2 cases / 1 death
    • France: 2 cases / 1 death
    • Italy: 1 case / 0 deaths
    • Greece: 1 case / 0 deaths
  • Africa:
    • Tunisia: 3 cases / 1 death
  • Asia:
    • Malaysia: 1 case / 1 death
    • Philippines: 1 case / 0 deaths
  • Americas:
    • United States of America: 1 case / 0 deaths

Sixteen cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), Italy (1), Malaysia (1), Philippines (1), Greece (1) and USA (1).

In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases.

Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

WHO reported yesterday a case in Yemen who died on 31 March 2014.This is the first case of MERS-CoV reported in Yemen. The patient was a 44 year-old male residing in Shibam (Yemen) who worked as an aircraft maintenance engineer and had hepatitis B. He had no history of travel during the last one month of his illness and no contact to a known confirmed case but had contact with passengers at the airport. In addition, he is reported to have visited a camel farm on a weekly basis and drank fresh camel milk.

On 2 May 2014, the US IHR National Focal Point reported the first laboratory confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) infection in US citizen. The man in his 60s lives and works in Riyadh, Saudi Arabia. He traveled to the US from Riyadh to Chicago on 24 April 2014 via London Heathrow with travel from Chicago to Indiana by bus. The onset of symptoms with a low-grade fever without any respiratory symptoms began on 14 April 2014. On 27 April 2014, he developed shortness of breath, cough, increasing fever, and mild runny nose. On 28 April 2014, he was seen in an emergency room. The patient was placed in private room.

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ECDC assessment

The source of MERS-CoV infection and the mode of transmission have not been identified, but the continued detection of cases in the Middle East indicates that there is an ongoing source of infection in the region.

Dromedary camels are likely an important host species for the virus, and many of the primary cases in clusters have reported direct or indirect camel exposures.

Almost all of the recently reported secondary cases, many of whom are asymptomatic or have only mild symptoms, have been acquired in healthcare settings.

There is therefore a continued risk of cases presenting in Europe following exposure in the Middle East, and international surveillance for MERS-CoV cases is essential.

An international case-control study has been designed and proposed by WHO. Results of this or similar epidemiological studies in order to determine the initial exposures and risk behaviours among the primary cases are urgently needed.

The risk of secondary transmission in the EU remains low and can be reduced further through screening for exposure among patients presenting with respiratory symptoms (and their contacts) and strict implementation of infection prevention and control measures for patients under investigation.

The case detected in Malaysia had participated in the muslim pilgrimage Umrah. However, more details are needed on possible and suspected exposure events, and it is possible that these cases were infected when visiting healthcare facilities in the region.

 

Actions

ECDC published an epidemiological update on 30 April 2014. The last update of a rapid risk assessment was published on 25 April 2014.

The first 133 cases are described in Eurosurveillance, published on 26 September 2013. ECDC is closely monitoring the situation in collaboration with WHO and EU Member States.

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