[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]


Week 40 4-10 October 2013


Middle East respiratory syndrome- coronavirus (MERS CoV)

Epidemiological Summary:

As of 10 October 2013, there have been 141 laboratory-confirmed cases of MERS-CoV worldwide, including 62 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East.

Saudi Arabia has reported 119 symptomatic or asymptomatic cases including 51 deaths, Jordan two cases, who both died, United Arab Emirates five cases, including one fatality and Qatar three cases, including two deaths.

Twelve cases have been reported from outside the Middle East: in the UK (4), France (2), Tunisia (3), Germany (2) and Italy (1). There have been no cases reported from outside the Arabian peninsula after 1 June 2013.

In France, Tunisia and the United Kingdom, there has been local transmission among patients who have not been to the Middle East but have been in close contact with laboratory-confirmed or probable cases.

Person-to-person transmission has occurred both among close contacts and in healthcare facilities. However, with the exception of a possible nosocomial outbreak in Al-Ahsa, Saudi Arabia, secondary transmission has been limited. Sixteen asymptomatic cases were reported by Saudi Arabia and two by the UAE. Seven of these cases were healthcare workers.

The Ministry of Health of Saudi Arabia updated its Health Regulations for travellers to Saudi Arabia for the Umrah and Hajj pilgrimage regarding MERS-CoV and now recommends that the elderly, those with chronic diseases, pilgrims with immune deficiency, malignancy and terminal illnesses, pregnant women and children coming for Hajj and Umrah this year should postpone their journey. This year, the pilgrimage takes place from 13 to 18 October.

WHO published a travel advice on MERS-CoV for pilgrims on 25 July 2013.
On 18 September WHO has issued an interim recommendation to laboratories and stakeholders involved in laboratory testing for Middle East respiratory syndrome coronavirus (MERS-CoV).

The WHO third meeting of the Emergency Committee on 25 September 2013 concluded that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.


ECDC Assessment:

The continued detection of MERS-CoV cases in the Middle East indicates that there is an ongoing source of infection present in the region. The source of infection and the mode of transmission have not been identified. There is therefore a continued risk of cases occurring in Europe associated with travel to the area.

Surveillance for cases is essential, particularly with expected increased travel to Saudi Arabia for the Hajj in October.

The risk of secondary transmission in the EU remains low and could be reduced further through screening for exposure among patients presenting with respiratory symptoms and their contacts, and strict implementation of infection prevention and control measures for patients under investigation.

Actions Summary:

The latest ECDC rapid risk assessment was published on 26 September 2013. The results of an ECDC coordinated survey on laboratory capacity for testing the MERS-CoV in Europe were published in EuroSurveillance. ECDC published a Public Health Development on 27 August 2013 regarding the isolation of MERS-CoV from a bat sample. The first 133 cases are described in EuroSurveillance published on 26 September 2013. ECDC is closely monitoring the situation in collaboration with WHO and the EU Member States.