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Middle East respiratory syndrome coronavirus - Kingdom of Saudi Arabia
15 October 2026Situation at a glance
Between 1 January and 5 October 2026, the Kingdom of Saudi Arabia reported eight laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, including one death. Cases were detected across six locations: Al Jouf (1), Arar (1), Hafr Al-Batin (1), Riyadh (2), Tabuk (1) and Taif (2). No epidemiological links were identified between any of the cases. All eight cases were symptomatic, most commonly presenting with fever (6/8), dyspnea (5/8), and cough (4/8). None were health and care workers. Infection was confirmed by RT-PCR testing. MERS is a zoonotic viral respiratory disease for which dromedary camels serve as the primary animal reservoir and two cases reported direct contact with camels while six reported no known camel exposure. Seven of eight cases had underlying comorbidities, recognized risk factors for severe MERS-CoV disease. The cases appear to represent sporadic infections related to zoonotic spillover rather than a single outbreak cluster.Description of the situation
Between 1 January and 5 October 2026, a total of eight cases of MERS-CoV, including one death, was reported from six locations in the Kingdom of Saudi Arabia. Of the eight reported cases, five occurred among persons aged 70 years and older, two among adults aged 50–59 years, and one among an adult aged 30–39 years. Seven cases had underlying comorbidities, two reported direct camel contact, and one death was reported in an older adult (>65 year old) with comorbidities. There was no known epidemiological link identified among cases.Case 1: A male aged 50–59 years, with comorbidities, from Al Jouf developed symptoms on 14 March 2026. He reported no known contact with camels or camel products. The patient was hospitalized on 17 March and laboratory confirmation of MERS-CoV infection was obtained by RT-PCR on 19 March.
Case 2: A male aged ≥70 years, with comorbidities, from Taif developed symptoms on 18 April 2026. He reported no known contact with camels or camel products. The patient was hospitalized on the same day, and laboratory confirmation was obtained on 22 April. He subsequently died as a result of the illness.
Case 3: A male aged ≥70 years, with comorbidities, from Hafr Al-Batin developed symptoms on 20 May 2026. He reported direct contact with camels. The patient was hospitalized on 26 May and laboratory confirmation was obtained on 27 May.
Case 4: A female aged ≥70 years, with comorbidities, from Riyadh developed symptoms on 31 July 2026. No known exposure to camels or camel products was reported. She was hospitalized on 3 August and laboratory confirmation was obtained on 8 August.
Case 5: A male aged 50–59 years, with comorbidities, from Tabuk developed symptoms on 20 August 2026. He reported no known contact with camels or camel products. He was hospitalized on 23 August and laboratory confirmation was obtained by RT-PCR on 24 August.
Case 6: A male aged 30–39 years, with no known comorbidities, from Riyadh developed symptoms on 14 August 2026. He reported no known contact with camels or camel products. He was hospitalized on 20 August and laboratory confirmation was obtained on 23 August.
Case 7: A male aged ≥70 years, with comorbidities, from Taif developed symptoms on 11 September 2026. He reported no known contact with camels or camel products. He was hospitalized on 17 September and laboratory confirmation was obtained on 19 September.
Case 8: A male aged 60–69 years, with comorbidities, from Arar developed symptoms on 20 September 2026. He reported direct contact with camels. He was hospitalized on 20 September and laboratory confirmation was obtained on 21 September.
Epidemiology
Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. The CFR is calculated based solely on laboratory-confirmed infections, which may not reflect the correct mortality rate.Humans contract MERS-CoV through direct or indirect contact with dromedary camels, the virus’s natural host and zoonotic reservoir. Human-to-human transmission is possible and occurs predominantly among close contacts (family and household members) and in health-care settings (health-care workers and among patients). The largest outbreaks occurred in health-care facilities in the Republic of Korea, Saudi Arabia, and the United Arab Emirates. Outside these environments, there has been limited documented human-to-human transmission to date.
MERS can present with no symptoms, mild respiratory issues, or severe illness leading to acute respiratory distress and death. Common symptoms include fever, cough, and breathing difficulties, with pneumonia frequently observed, though not always present. Some patients also experience gastrointestinal symptoms such as diarrhoea. Severe cases may require intensive care, including mechanical ventilation. Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders.
No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.
Public health response
The Kingdom of Saudi Arabia has incorporated MERS-CoV testing into sentinel surveillance algorithms, with testing conducted among patients who test negative for influenza and SARS-CoV-2. This approach aims to improve case detection given the overlapping clinical presentation of MERS, COVID-19, influenza and other respiratory infections. Additionally, IPC practices have improved considerably since 2012, implementing regular training for health and care workers, IPC programmes in health facilities and at national level and improving IPC practices in healthcare settings.National health authorities continue to promote public awareness and risk reduction measures, particularly regarding zoonotic transmission from dromedary camels. Recommended measures include regular hand hygiene before and after animal contact, avoiding contact with sick animals, avoiding consumption of raw camel milk, camel urine, and undercooked camel meat, and seeking medical care when respiratory symptoms develop. The Ministry of Health also continues to promote respiratory hygiene measures, including covering coughs and sneezes, avoiding close contact with ill individuals, and maintaining good respiratory hygiene. In parallel, coordination has been established between the Public Health Authority and the National Center for the Prevention and Control of Plant Pests and Animal Diseases. Appropriate control measures have been implemented for involved camels in accordance with animal health recommendations.
Contact tracing has been conducted for all confirmed cases; no secondary cases have been identified to date. Enhanced infection prevention and control (IPC) measures remain in place at healthcare facilities. Health and care workers who are exposed before patients are isolated or identified as being infectious, were followed up and no secondary cases have been reported in healthcare facilities as a result of these cases.
WHO risk assessment
MERS is a zoonotic viral respiratory disease caused by MERS-CoV, for which dromedary camels serve as the primary animal reservoir. Human infection can range from asymptomatic or mild illness to severe disease and death. Human infections continue to occur through direct or indirect exposure to infected dromedaries or their products, while limited human-to-human transmission has been documented, primarily among close contacts and in healthcare settings. Sustained community transmission has not been observed. No licensed vaccine for MERS-CoV exists to date.As of 5 October 2026, WHO had been notified of 2643 laboratory-confirmed MERS cases globally, including 965 deaths, since the virus was first identified in 2012. The majority of cases (84%; 2232 cases and 870 deaths) have been reported from Saudi Arabia. These figures likely underestimate the true number of infections since mild and asymptomatic cases may remain undetected/unreported, while the reported case fatality of ratio of 37% may overestimate mortality among infections.
Although the number of reported MERS cases has declined substantially since 2020, MERS-CoV continues to circulate in dromedary camel populations in the Middle East and African regions and continues to cause sporadic human infections. The observed decline in reported MERS cases, in particular during the COVID-19 pandemic emergency phase, is thought to be a result of pandemic-related IPC measures that also limited human-to-human transmission of MERS-CoV, as well as behavioral changes during the pandemic. Any role of potential cross-reactive immunity from SARS-CoV-2 infection and/ or vaccination remains in need of further investigation. Other hypotheses—such as reduced surveillance, viral attenuation, or decreased circulation in camel populations—are not supported by current evidence.
WHO expects additional sporadic MERS cases to occur in countries where the virus circulates in camels and anticipates that travel-associated exportation of cases will continue. Delays in detection remain possible due to the clinical presentation of MERS being similar with other respiratory infections, including influenza and COVID-19. Numerous outbreaks in KSA and the Republic of Korea have demonstrated that primary cases can result in substantial secondary transmission, particularly in healthcare settings and through importation of travel related cases.
The notification of the recent cases in Saudi Arabia does not change WHO's overall risk assessment - the risk remains moderate at both the regional and global levels, reflecting the continued occurrence of sporadic zoonotic infections, the potential for healthcare-associated outbreaks and international exportation of cases, in the absence of sustained human-to-human transmission.
WHO continues to monitor the epidemiological situation through routine surveillance and reporting under the International Health Regulations (IHR 2005) and conducts ongoing risk assessments using available epidemiological and virological information.
WHO advice
Based on the current situation and available information, WHO re-emphasizes the importance of maintaining strong surveillance for acute respiratory infections in all Member States. Where warranted by the epidemiological context, MERS-CoV should be included in the testing algorithm and included in differential diagnosis for patients presenting with acute respiratory illness and reporting history of travel to affected areas, and any unusual patterns of respiratory illness or severe acute respiratory infections should be carefully reviewed.Human-to-human transmission of MERS-CoV in healthcare settings has been associated with delays in recognizing acute respiratory symptoms of MERS-CoV infection as they are often non-specific and similar to other respiratory illnesses, leading to delayed triage of suspected cases and delayed implementation of IPC measures — both critical to prevent the spread of MERS-CoV in healthcare facilities and if left unmanaged have led to large healthcare outbreaks (example of the Republic of Korea in 2015). Health and care workers should consistently apply standard precautions for all patients at every interaction in healthcare settings. In addition, transmission-based precautions should be implemented when caring for patients with symptoms of acute respiratory infection who are suspected of having a viral infection, including suspected, probable or confirmed MERS-CoV infection. Contact and droplet precautions should be applied, while airborne precautions should be implemented when performing aerosol-generating procedures. Early identification, case management and prompt isolation of cases, contact tracing, together with appropriate IPC measures in healthcare settings and public health awareness, can reduce the risk of human-to-human transmission of MERS-CoV.
MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease and in immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with dromedary camels or their products, particularly when visiting farms, markets, barns or other areas where the virus may be circulating.
General hygiene measures should be followed when interacting with animals or animal products, including regular hand washing before and after touching animals and avoiding contact with sick animals.
Appropriate food hygiene should be observed when handling or consuming camel products. People should avoid drinking raw camel milk or camel urine or consuming meat that has not been properly cooked.
WHO does not advise special screening at points of entry in relation to this event, nor does it currently recommend the application of any travel or trade restrictions.
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Middle East respiratory syndrome coronavirus - Kingdom of Saudi Arabia
Between 1 January and 5 October 2026, the Kingdom of Saudi Arabia reported eight laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, including one death. Cases were detected across six locations: Al Jouf (1), Arar (1), Hafr Al-Batin (1), Riyadh (2)...