Middle East respiratory syndrome coronavirus (MERS-CoV): update on cases- 22nd May 2013


The Ministry of Health in Tunisia has notified WHO of two laboratory-confirmed cases and a probable case of infection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). These are the first confirmed cases of infection with MERS-CoV in Tunisia.

The two laboratory confirmed cases were siblings, a 34-year-old man and a 35-year-old woman. Both of whom had mild respiratory illness and did not require hospitalisation. Retrospective investigation into the cases revealed that the probable case, their father, a 66 year old, became ill three days after returning from a visit to Qatar and Saudi Arabia on 3 May 2013. He was hospitalised after developing acute respiratory disease, his condition deteriorated and he died on 10 May 2013. He had an underlying health condition. Initial laboratory tests conducted on the probable case tested negative for MERS-CoV. Further investigation into this outbreak is ongoing and close contacts of the family are being monitored for any unusual signs of illness.

In Saudi Arabia, a patient earlier reported as part of the ongoing investigation into an outbreak that began in a health care facility since the beginning of April 2013, has died. To date, a total of 22 patients including 10 deaths have been reported from this outbreak in the Eastern part of Saudi Arabia. The government is conducting an ongoing investigation into the outbreak.

From September 2012 to date, WHO has been informed of a global total of 43 laboratory-confirmed cases of infection with MERS-CoV, including 21 deaths. Several countries in the Middle East have been affected, including Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). Cases have also been reported by four additional countries: France, Germany, Tunisia and the United Kingdom. All of the cases have had a direct or indirect connection to the Middle East, including two cases with recent travel history from the UAE. In France and the United Kingdom, there has been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a traveller who recently returned from the Middle East.

On May 17th the European Centre for Disease Prevention and Control issued an updated rapid risk assessment on MERS-CoV.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Any clusters of SARI or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur.

Testing for MERS-CoV should be considered in patients with unexplained pneumonias, or in patients with unexplained severe, progressive illness or complicated respiratory illness not responding to treatment, particularly in persons travelling from or resident in areas of the world known to be affected i.e. Arabian peninsula and surrounding countries.

Health care facilities that provide care for patients with suspected MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors. Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC) measures.

Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms such as diarrhoea in patients who are significantly immunocompromised.

New cases and clusters of MERS-CoV should be promptly reported to local Departments of Public Health.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to monitor the situation closely.

For more information see http://www.hpsc.ie/hpsc/A-Z/Respiratory/CoronavirusInfections/

See also:
Health Protection Agency UK
World Health Organization

World Health Organization-Europe
European Centre for Disease Prevention and Control