WHO

From 1 June through 16 September 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported 32 additional cases of Middle East Respiratory Syndrome (MERS), including 10 deaths.

Among these 32 cases, 12 cases were part of five distinct clusters (one health care and four household clusters). The details of these clusters are described below and detailed information concerning the cases reported can be found in a separate document (see link below).

• Cluster 1: From 1 through 8 June, four additional cases in a previously reported household cluster were reported in Najran, Saudi Arabia. The initial case reported in this cluster was reported on 30 May (aged 52 years old). One of the secondary cases was a health care worker.
• Cluster 2: From 9 through 14 July, a household cluster of two cases was reported from Afif city, Riyadh region. No health care workers were infected.
• Cluster 3: From 3 through 4 September, a health care facility in Buraidah City, Al-Quassim Region reported a cluster of two patients. No other patients or health care workers were infected.
• Cluster 4: From 1 through 16 September, a household cluster of two cases, including the suspected index case with reported dromedary exposure was reported from Buraidah City, Al-Quassim Region. No health care workers were infected.
• Cluster 5: From 10 through 16 September, a household cluster of two cases, including the suspected index case with reported dromedary exposure were reported from Riyadh City, Riyadh Region. No health care workers were infected.

• MERS-CoV cases reported between 1 June and 16 September 2018
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From 2012 through 16 September 2018, the total global number of laboratory-confirmed MERS cases reported to WHO is 2254 and 800 associated deaths.

The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR 2005 to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained 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 camels) 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.

MERS-CoV causes more severe disease in people with underlying chronic conditions such as diabetes, renal failure, chronic lung disease, and immunocompromised persons. 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.