Posted on 23RD AUG 2018
tagged MERS-CoV, United Kingdom

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 23 Aug 2018
Source: Public Health England [edited]

Public Health England (PHE) confirms that an individual has been diagnosed with Middle East respiratory syndrome (MERS) in England. The patient was initially admitted to a hospital in Leeds and was transferred to Royal Liverpool Hospital, an expert respiratory infectious disease centre, where they are [sic] stable and receiving appropriate treatment. The patient is a resident of the Middle East, where they are [sic] believed to have contracted the infection before travelling to the UK.

While this is a serious infection for the individual, the risk of transmission to the general population from this case is very low. MERS-CoV (the virus that causes MERS) can be spread when someone is in close contact with a patient for a sustained period of time. This means there is a very low risk to the general population of becoming ill.

This is the 5th case of MERS diagnosed in England, with previous cases diagnosed in 2012 to 2013.

As a precautionary measure, PHE experts are working closely with NHS colleagues to advise them on infection-control measures. They will be contacting people who might have been in close contact with the individual to monitor their symptoms and provide health advice. This will include contacting a number of passengers who travelled in close proximity to the patient on the same flight to the UK.

People without symptoms are not considered infectious but, as a precaution, those who have been in close proximity will be contacted and monitored to ensure that, if they do become ill, they can be treated quickly.

If people show symptoms of MERS after travelling to the Middle East, our advice remains unchanged, and they should contact health services through the usual routes by calling their GP or NHS 111.

Typically, MERS symptoms include fever, cough, and shortness of breath. Healthcare professionals are advised to remain vigilant for severe unexplained respiratory illness occurring in anyone who has recently travelled into the UK from the Middle East, particularly in light of increased travel associated with the Hajj.

Dr Jenny Harries, deputy medical director at PHE, said, "A patient in a hospital in Liverpool is being treated for Middle East Respiratory Syndrome coronavirus (Mers-CoV) infection. The patient is thought to have contracted the infection whilst in the Middle East before travelling to the UK."

"Public Health England is following up with those who have had close and sustained contact with the patient to offer advice and to monitor them as necessary. It is important to emphasise that, although a case has been identified, the overall risk of disease transmission to the public is very low. As we've seen in previous cases, we have well-established and robust infection-control procedures for dealing with cases of imported infectious disease, and these will be strictly followed to minimise the risk of transmission."


- No further details about the patient will be provided due to patient confidentiality.

- The patient was 1st assessed, diagnosed, and treated at Leeds Teaching Hospitals NHS Trust before being transferred to the specialist unit in Liverpool. The NHS will not issue daily condition checks. An update will only be provided if there is a significant change to the patient's condition.

- The patient travelled on Saudi Arabian Airlines flight no. SV123 on [Thu 16 Aug 2018]. Aircraft recycle and filter the air in the cabin, and this is why contact tracing is usually restricted to 3 rows in front and 3 behind the case. If you have not been contacted, then you are not considered at risk.

- The total number of laboratory-confirmed cases detected in the UK is now 5: the current case, 2 imported from the Middle East in 2012-2013, and 2 as a result of onward transmission from one of the cases whilst in the UK. General travel health advice for travellers going to the Middle East is available from NaTHNaC's website, TravelHealthPro.

- MERS guidance issued by PHE for clinicians can be accessed from Middle East respiratory syndrome coronavirus (MERS-CoV): clinical management and guidance.

- Health-advice posters are available on the PHE website.

- MERS symptoms typically include fever, cough, and shortness of breath. Pneumonia is common but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.

Public Health England press officer

Communicated by:
R Record
Infectious Disease Post-Doc

[Presumably more information on the epidemiologic investigation of this case will become available through additional press releases from PHE and/or tenacious journalists seeking to clarify the situation further. The fact that this case travelled on a Saudi Arabian Airlines flight suggests the individual might be a Saudi resident but does not confirm this, as people do choose to travel on airlines of preference or find flights of lesser cost that have changes of flights in other countries. A curiosity was the use of "they" in referring to the infected individual (which we have marked with [sic]). As one doesn't expect this sort of grammatical error in official government releases, one can't help but wonder if there were accompanying family members who are under observation as well.

Rather than continue to speculate, I think it is best to close this comment with a request for further information on the epidemiology of this case, including possible locations of exposure (country and 1st administrative division in country of exposure as well as identified high-risk exposures of this infected individual. Demographic information is always interesting from an epidemiologic perspective as well.

HealthMap/ProMED-mail maps:
England, United Kingdom: <>
Middle East: <> - Mod.MPP]

See Also
MERS-CoV (27): Saudi Arabia clarification, outcome update, WHO 20180820.5977355
MERS-CoV (26): Saudi Arabia, abattoir workers (Nigeria), primary camel exposure 20180818.5972601
MERS-CoV (25): risk assessment, WHO 20180808.5954813
MERS-CoV (24): Saudi Arabia, MoH reports 20180807.5950858
MERS-CoV (23): Saudi Arabia, WHO, RFI 20180711.5899938
MERS-CoV (22): Saudi Arabia, WHO 20180629.5862285
MERS-CoV (21): EMRO/WHO update May 2018 20180612.5852927
MERS-CoV (20): Saudi Arabia (NJ) susp. family cluster 20180602.5835120
MERS-CoV (10): Oman, Saudi Arabia, WHO 20180315.5690014
MERS-CoV (01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman) 20180102.5532148
MERS-CoV (77): Saudi Arabia, camels, human, epidemiology, assessment 20171222.5520561
MERS-CoV (01): Saudi Arabia (QS, RI, MD) RFI 20170105.4744802
MERS-CoV (123): Saudi Arabia (MK, AS) new cases 20161231.4734758
MERS-COV (01): Oman, Saudi Arabia 20160105.3911188
MERS-COV (167): acute management and long-term survival 20151231.3904300
MERS-CoV (01): Saudi Arabia, new cases, new death 20150104.3069383
MERS-CoV (69): Saudi Arabia, new case, RFI 20141230.306305
MERS-CoV (01): Bangladesh, KSA, Algeria, UAE, Iran, WHO, RFI 20140616.2541707
MERS-CoV - Eastern Mediterranean (82): anim res, camel, seroepidemiology 20140613.2537848
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean: Saudi Arabia, new case, RFI 20130518.1721601
Novel coronavirus - Eastern Mediterranean (29): MERS-CoV, ICTV nomenclature 20130516.1717833
Novel coronavirus - Eastern Mediterranean: bat reservoir 20130122.1508656
Novel coronavirus - Eastern Mediterranean (06): comments 20121225.1468821
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733