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

Between 3 and 10 November 2016 the National IHR Focal Point of Saudi Arabia reported six (6) additional cases of Middle East Respiratory Syndrome (MERS). Two (2) deaths among previously reported MERS cases were also reported.

Details of the cases

• A 68-year-old male national living in Alkharj city, Riyadh Region. He developed symptoms on 1 November and was admitted to hospital on 8 November. The patient who has comorbidities, tested positive for MERS-CoV on 9 November. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition admitted to ICU but not on mechanical ventilation.
• A 53-year-old male national, living in Alkharj city, Riyadh Region. He developed symptoms on 2 November and was admitted to hospital on 7 November. The patient who has comorbidities, tested positive for MERS-CoV on 8 November. He has a history of contact with camels and consumption of their raw milk in the 14 days prior to the onset of symptoms. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward. The Ministry of Agriculture was informed and investigation of camels is ongoing.
• A 58-year-old female non-national living in Najran city, Najran Region. She developed symptoms on 30 October and was admitted to hospital on 5 November. The patient who has comorbidities, tested positive for MERS-CoV on 7 November. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward.
• A 52-year-old male national living in Bahrah city, Makkah Region. He developed symptoms on 26 October and was admitted to hospital on 3 November. The patient who has comorbidities, tested positive for MERS-CoV on 5 November. He has a history of contact with camels and consumption of their raw milk in the 14 days prior to the onset of symptoms. Currently the patient is in critical condition admitted to ICU but not on mechanical ventilation. Ministry of Agriculture has been informed and investigation of camels is ongoing.
• A 61-year-old male national living in Buridah city, Qassim Region. He developed symptoms on 27 October and was admitted to hospital on 1 November. The patient who has comorbidities, tested positive for MERS-CoV on 3 November. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition admitted to ICU but not on mechanical ventilation.
• A 94-year-old male national, living in Buridah city, Qassim Region. He developed symptoms on 29 October and was admitted to hospital on 31 October. The patient who has comorbidities, tested positive for MERS-CoV on 2 November. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition admitted to ICU but not on mechanical ventilation.

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

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 previously reported MERS-CoV cases. See case numbers 1 and 11 in DON published on 11 November 2016.

Globally, since September 2012, WHO has been notified of 1832 laboratory-confirmed cases of infection with MERS-CoV including at least 651 related deaths have been reported to WHO.

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 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.