Increase in the number of MERS-CoV cases in the Middle East


A marked and sudden increase in the number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases was reported in April 2014. The European Centre for Disease Prevention and Control (ECDC) states that the majority of cases were in Saudi Arabia and the Middle East but in early April, a confirmed case in Greece brought the total number of EU affected countries to five (France, Germany, Greece, Italy and the UK). The cause of the rapid increase in cases is unknown. Almost all of the recently reported secondary cases, many of whom are asymptomatic or have only mild symptoms, have been acquired in healthcare settings. There is therefore a continued risk of cases presenting in Europe following exposure in the Middle East and international surveillance for MERS-CoV cases is essential.

According to ECDC as of April 23rd 2014, 345 laboratory confirmed cases of MERS-CoV have been reported worldwide, including 107 deaths (case fatality ratio: 31%). Fourteen countries have identified cases; four of which have only reported one case, whilst 272 (79%) cases have been in Saudi Arabia. Fifteen cases have been reported outside of the Middle East including ten in Europe. The remaining five occurred in North Africa (Tunisia) and Asia (Malaysia and the Philippines). Seventy-two of the 345 (21%) cases have been healthcare workers.   

The source of MERS-CoV infection and the mode of transmission have not been identified, but the continued detection of cases in the Middle East indicates that there is an ongoing source of infection in the region. There is growing evidence that the dromedary camel is a host species for MERS-CoV and that they play an important role in the transmission to humans. Many of the primary cases in clusters have reported direct or indirect camel exposures.

In this context, ECDC updated their MERS-CoV risk assessment on April 24th. The World Health Organization (WHO) also issued their updated risk assessment on the situation on April 24th

Both are recommending increased vigilance among healthcare providers in assessing patients with a travel history to the Middle East especially those presenting with severe acute respiratory symptoms and diarrhoea.

Returning travellers from the Middle East who develop respiratory symptoms such as cough, fever, shortness of breath, or diarrhoea within 14 days of returning should seek urgent medical attention. They should tell their healthcare provider in advance that you have recently returned from the Middle East to ensure that appropriate measures are taken and testing considered. Irish travel advice is available on the HPSC website.

The latest information from the World Health Organization (WHO) on MERS-CoV including case updates is available at WHO Coronovirus Infections and WHO Disease Outbreak News.

See also the Health Protection Surveillance Centre website at