Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea

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On June 17th, the World Health Organization’s (WHO) IHR Emergency Committee regarding MERS-CoV met for the ninth time to consider the outbreak in the Republic of Korea (South Korea). The Committee concluded that the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak was not a Public Health Emergency of International Concern (PHEIC). However, the Committee expressed its assessment that this outbreak is a wakeup call and that in a highly mobile world, all countries should always be prepared for the unanticipated possibility of outbreaks of this, and other serious infectious diseases. The situation highlights the need to strengthen collaboration between health and other key sectors, such as aviation, and to enhance communication processes.

WHO does not recommend any travel or trade restrictions and stated that screening at points of entry was unnecessary at this time.

Epidemiological Update
As of 2nd July, 183 laboratory-confirmed cases of infection with MERS-CoV, including 33 related deaths, associated with the MERS-CoV outbreak in the Republic of Korea have been officially report to WHO.

Globally, since September 2012, WHO has been notified of 1,357 laboratory-confirmed cases of infection with MERS-CoV, including at least 486 related deaths.

Risk Assessment
The European Centre for Disease Prevention and Control (ECDC) published its 17th risk assessment on MERS-CoV on 11th June 2015. This states that currently the risk of MERS-CoV infection in Europe remains low. Because of the continued risk of case importation to Europe after exposure in the Middle East and the Republic of Korea, international surveillance for MERS-CoV cases among travellers remains essential.

Recommendations from the WHO
As a general precaution, travellers to the Middle East who visit farms, markets, barns or other places where animals are present should practise general hygiene measures as follows:

  • Regular hand washing after touching animals,
  • Avoid touching eyes, nose or mouth with hands
  • Avoid contact with sick animals.

The consumption of raw or undercooked animal products including milk and meat carries a high risk of infection from a variety of organisms that might cause human illness. Animal products (including camel milk) processed appropriately through proper cooking or pasteurisation are safe for consumption but should be handled with care to avoid cross-contamination with uncooked food.

Recommendations for at-risk groups
Until more is understood about MERS, 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. Especially in the Middle East people should avoid contact with camels, consuming raw camel milk or camel urine, as well as eating meat that has not been properly cooked.

WHO has issued specific travel advice on MERS-CoV for pilgrimages. See also HPSC website for travel advice.

In addition persons returning from the Middle East and the Republic of Korea who develop symptoms such as cough, fever, shortness of breath, or diarrhoea within 14 days of returning should seek urgent medical attention, and tell the doctor their recent travel history.

Information for the Acute Sector
A recent joint mission by WHO and the Republic of Korea identified the factors that promoted of spread of MERS-CoV in this hospital-based outbreak:

  1. Lack of awareness among healthcare workers and the general public about MERS-CoV;
  2. Suboptimal infection prevention and control measures in hospitals;
  3. Close and prolonged contact of infected MERS patients in crowded emergency rooms and multibed rooms in hospitals;
  4. The practice of seeking care at multiple hospitals ("doctor shopping");
  5. The custom of many visitors or family members staying with infected patientes in the hospital rooms facilitating secondary spread of infections among contacts. 

The main points to note for clinicians/public health at this time are:

  • Continued clinical vigilance and awareness of the possibility of MERS Co-V in patients presenting with severe acute respiratory infection having had either:
    • recent contact with healthcare services in the Republic of Korea and or
    • those who have returned from the Middle East
  • The possibility of atypical presentations in the immunosuppressed
  • The crucial importance of eliciting a travel history from patients with severe respiratory disease - this cannot be overemphasised.
  • The prompt, systematic and strict implementation of infection prevention and control measures for such patients presenting in healthcare facilities is essential to interrupt transmission and to prevent healthcare-associated infections from MERS-CoV.

Further information:
WHO: Coronavirus infections
ECDC: Coronavirus infections
HPSC: Coronavirus infections