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


Week 16, 13-19 April 2014


Middle East respiratory syndrome- coronavirus (MERS CoV) Multistate

Opening date: 24 September 2012 Latest update: 17 April 2014

Epidemiological summary

Since April 2012 and as of 18 April 2014, 275 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 98 deaths and 64 healthcare workers.

The following countries have reported MERS-CoV cases:
  1. Saudi Arabia: 212 cases / 72 deaths
  2. United Arab Emirates: 33 cases / 9 deaths
  3. Qatar: 7 cases / 4 deaths
  4. Jordan: 4 cases / 3 deaths
  5. Oman: 2 cases / 2 deaths
  6. Kuwait: 3 cases / 1 death
  7. UK: 4 cases / 3 deaths
  8. Germany: 2 cases / 1 death
  9. France: 2 cases / 1 death
  10. Italy: 1 case / 0 death
  11. Tunisia: 3 cases / 1 death
  12. Malaysia: 1 case / 1 death
  13. Philippines: 1 case / 0 death

Fourteen cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), Italy (1),
Malaysia (1) and Philippines (1).

In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.

In the first 18 days of April 2014, 57 cases (21% of total cases) have been reported, 29 of whom are healthcare workers (51%) and 21 are asymptomatic cases.

In the United Arab Emirates, a cluster of 14 healthcare workers (including one case exposed in UAE and reported by the Philippines) has been reported during the past week. They all had had contact with a previously reported case, who died on 10 April 2014. Eight of the cases had mild symptoms and six were asymptomatic.

In Saudi Arabia, during the past week, 30 cases have all occurred in Jeddah, including 11 healthcare workers; five cases were fatal and eight were asymptomatic.

The first cases reported in Asia have occurred in people returning from the Middle East:
  • The case from the Philippines is an asymptomatic healthcare worker returning from the United Arab Emirates.
  • The case in Malaysia was in a 54-year-old man who returned from Saudi Arabia after Umrah on 29 March 2014. He developed symptoms (fever, coughing) around 8 April 2014. On 10 April 2014, he was admitted to hospital and died on 13 April 2014. The
    Malaysian health authorities are conducting prevention and control activities including monitoring close contacts of the case.


ECDC assessment

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.

Dromedary camels are likely an important host species for the virus, and many of the primary cases in clusters have reported direct or indirect camel exposures.

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.

An international case-control study has been designed and proposed by WHO. Results of this or similar epidemiological studies to determine the initial exposures and risk behaviours among the primary cases are urgently needed.

The risk of secondary transmission in the EU remains low and can 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.

The case detected in Malaysia last week had participated in the muslim pilgrimage Umrah. However, more details are needed on possible and suspected exposure events and it is possible that these cases were also infected when visiting healthcare facilities in the region.

The Malaysian authorities have asked all passengers travelling on the flights with the case detected in Malaysia on 29 March to be screened for health complaints.

The Philippines authorities have asked all passengers travelling with the Filipino case detected on 15 April to be screened for signs and symptoms of MERS-CoV infection, while the department of health is also actively contact tracing passengers.


ECDC's latest epidemiological update was published on 25 November 2013. The latest update of a rapid risk assessment was published on 7 November 2013. The first 133 cases are described in Eurosurveillance published on 26 September 2013. ECDC is closely monitoring the situation, in collaboration with WHO and EU Member States.