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20 Dec 2013

Middle East respiratory syndrome- coronavirus (MERS CoV)–Multistate (ECDC/CDTR, December 20 2013, extract)

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


Week 51, 15-21 December 2013



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

Opening date: 24 September 2012 Latest update: 19 December 2013


Epidemiological summary

As of 20 December 2013, 165 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 71 deaths.

Saudi Arabia has reported 116 symptomatic and 16 symptomatic cases including 55 deaths; Jordan two fatal cases; United Arab Emirates 9 cases, including three deaths; Qatar seven cases, including five deaths; Oman one fatal case and Kuwait two cases.

Twelve cases have been reported from outside the Middle East: in the UK (4), France (2), Tunisia (3), Germany (2) and Italy (1).

In France, Tunisia and the United Kingdom, there has been local transmission among patients who have not been to the Middle East but have been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities. However, with the exception of a possible nosocomial outbreak in Al-Ahsa, Saudi Arabia, secondary transmission has been limited. Sixteen asymptomatic cases have been reported by Saudi Arabia and two by the United Arab Emirates (UAE). Seven of these cases were healthcare workers.

The 4th meeting of the IHR Emergency Committee concerning MERS-CoV was held on 4 December 2013. The Committee concluded that it saw no reason to change its previous advice to the Director-General. Their unanimous decision was that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

Based on events since its last meeting, the Committee emphasised the need for:

  • investigative studies, including international case-control, serological, environmental, and animal-human interface studies, to better understand risk factors and the epidemiology
  • further review and strengthening of such tools such as standardised case definitions and surveillance, and further emphasis on infection control and prevention.

A study published in The Lancet Infectious Diseases indicates that dromedary camels on a farm in Qatar were infected with a strain of MERS-CoV nearly identical to that found in two people associated with the farm which suggests a recent outbreak affecting both humans and camels. However, this study could not conclude whether people on the farm were infected by the camels or vice versa, or if a third source was responsible.



ECDC assessment

The continued detection of MERS-CoV cases in the Middle East indicates that there is an on-going source of infection present in the region. The source of infection and the mode of transmission have not been identified. There is therefore a continued risk of cases occurring in Europe associated with travel to the area. Surveillance for cases is essential.

The risk of secondary transmission in the EU remains low and could 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.



ECDC's latest epidemiological update was published on 25 November 2013. The latest update of a rapid risk assessment was published on 7 November 2013. 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.