WHO

Disease outbreak news
11 November 2016

Between 15 and 29 October 2016 the National IHR Focal Point of Saudi Arabia reported thirteen (13) additional cases of Middle East Respiratory Syndrome (MERS) including four (4) fatal cases.

A MERS outbreak has affected a hospital in Hofouf city, Al Ahssa Region. Four (4) cases are associated with this hospital outbreak. These cases are:

• A 73-year-old male reported to WHO on 15 October (believed to be the index case, see case number 13 below).
• A 33-year-old female reported to WHO on 17 October (see case number 12 below).
• A 61-year-old male reported to WHO on 21 October (see case number 7 below).
• A 55-year-old male reported to WHO on 23 October (see case number 4 below).

One additional case is also associated with the index case but not with the hospital outbreak. This case is a 40-year-old male reported to WHO on 21 October (ambulance driver who transferred the index case before he was identified as a MERS case and isolated, see case number 6 below).

A Rapid Response Team was dispatched and extensive contact tracing was initiated. A total of 27 healthcare contacts and 14 patients in the hospital were traced. Elective admissions have been suspended at the center, and necessary prevention and control measures put in place.

Details of the cases

• A 41-year-old male national living in Buridah city, Qassim Region. He developed symptoms on 12 October and was admitted to hospital on 27 October. The patient who has comorbidities tested positive for MERS-CoV on 28 October. Investigation of history of exposure to the known risk factors is ongoing. Currently the patient is in critical condition admitted to ICU but not on mechanical ventilation.
• A 65-year-old male non-national living in Arar city, Northern border Region. He developed symptoms on 24 October and was admitted to hospital on 25 October. The patient who has no comorbidities, tested positive for MERS-CoV on 26 October. He is one of the household contacts of the 58-year-old MERS case reported to WHO on 23 October (see case number 5 below) and was identified through tracing contacts. Currently the patient is in stable condition admitted to a negative pressure room on a ward.
• A 46-year-old male non-national living in Hofouf city, Al Ahssa Region. He developed symptoms on 18 October and was admitted to hospital on 22 October. The patient who has comorbidities, tested positive for MERS-CoV on 23 October. He had a history of contact with camels and their raw meat in the 14 days prior to the onset of symptoms. Currently the patient is in stable condition admitted to a negative pressure room on a ward. Ministry of Agriculture was informed and investigation of camels is ongoing.
• A 55-year-old male non-national works living in Hofouf city, Al Ahssa Region. He was admitted to the hospital, currently affected by the MERS outbreak, due to myocardial infarction on 2 October. On 20 October, while hospitalized, he developed symptoms and tested positive for MERS-CoV on 22 October. Investigation of possible epidemiological link with the MERS cases detected in the same hospital is ongoing. The patient was in critical condition admitted to ICU. He passed away on 22 October.
• A 58-year-old male non-national works living in Arar city, Northern border Region. He developed symptoms on 14 October and was admitted to hospital on 20 October. The patient who has comorbidities tested positive for MERS-CoV on 22 October. Investigation of history of exposure to the known risk factors is ongoing. The patient was in critical condition admitted to ICU but not on mechanical ventilation. He passed away on 27 October.
• A 40-year-old male national living in Uaryarah city, Eastern Region. He developed symptoms on 19 October and was admitted to hospital on 20 October. The patient who has no comorbidities tested positive for MERS-CoV on 21 October. On 13 October, he transported the 73-year-old MERS case reported to WHO on 15 October (see case number 13 below) by an ambulance to the hospital, currently affected by the MERS outbreak before the case was identified and isolated. Currently the patient is in stable condition in home isolation.
• A 61-year-old male national living in Hofouf city, Al Ahssa Region. He was admitted to the hospital currently affected by the MERS outbreak on 13 October for catheterization. On 14 October, he developed symptoms while hospitalized. The patient tested positive for MERS-CoV on 20 October. Investigation of possible epidemiological link with the MERS cases hospitalized in the same hospital is ongoing. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward.
• A 72-year-old female national living in Najran city, Najran Region. She developed symptoms on 13 October and was admitted to hospital on 16 October. The patient who has comorbidities tested positive for MERS-CoV on 20 October. Investigation of history of exposure to the known risk factors is ongoing. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward.
• A 53-year-old male national living in Abha city, Assir Region. He developed symptoms on 9 October and was admitted to hospital on 19 October. The patient who has comorbidities tested positive for MERS-CoV on 20 October. Investigation of history of exposure to the known risk factors is ongoing. The patient was in critical condition admitted to ICU but not on mechanical ventilation. He passed away on 22 October.
• A 47-year-old male non-national living in Buridah city, Qassim Region. He developed symptoms on 10 October and was admitted to hospital on 15 October. The patient who has no comorbidities tested positive for MERS-CoV on 17 October. He has a history of contact with camels and consumption of their raw milk in the two weeks prior the onset of symptoms. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward. Ministry of Agriculture was informed and investigation of camels is ongoing.
• A 72-year-old male national living in Riyadh city, Riyadh Region. He developed symptoms on 13 October and was admitted to hospital on 17 October. The patient who has comorbidities tested positive for MERS-CoV on 17 October. Investigation of history of exposure to the known risk factors is ongoing. Currently the patient is in critical condition admitted to ICU on mechanical ventilation.
• A 33-year-old female non-national in the hospital, currently affected by the MERS outbreak and living in Hofouf city, Al Ahssa Region. She is asymptomatic but identified through tracing contacts of the 73-year-old male MERS case reported to WHO on 15 October (see case number 13 below). The patient who has no comorbidities tested positive for MERS-CoV on 15 October. Currently she is in stable condition in home isolation.
• A 73-year-old male national living in Hofouf city, Al Ahssa Region. He developed symptoms on 10 October and was admitted to the hospital, currently affected by the MERS outbreak on 13 October. The patient who has comorbidities tested positive for MERS-CoV on 14 October. He has a history of contact with camels and consumption of their raw milk in the 14 days prior to the onset of symptoms. The patient was in stable condition admitted to a negative pressure isolation room on a ward but his conditions deteriorated and he passed away on 18 October. Ministry of Agriculture was informed and their investigation is ongoing.

Contact tracing of household and healthcare contacts is ongoing for these cases.

Globally, since September 2012, WHO has been notified of 1826 laboratory-confirmed cases of infection with MERS-CoV including at least 649 related deaths have been reported to WHO.

WHO risk assessment

The current health care associated cases reported are not changing the overall risk assessment but are underlying the need for continued surveillance and application of Infection prevention and control measures.

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 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.