Posted on 04TH SEP 2018
tagged MERS-CoV, Saudi Arabia

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

In this update:
[1] Saudi Arabia, 2 new cases - Saudi MOH 31 Aug 2018 - 1 Sep 2018
[2] UK (England) ex Saudi Arabia, WHO

[1] Saudi Arabia, 2 new cases - Saudi MOH 31 Aug 2018 - 1 Sep 2018
Date: Sat 1 Sep 2018
Source: Saudi MOH, Epidemiologic week 35 [edited]

Newly confirmed cases of MERS-CoV infection:

Case 18-1742
Date: Fri 31 Aug 2018
MERS in Aldwadmi city: 55-year-old female living in Aldwadmi city, Riyadh region
Contact with camels: no
Case classification: primary, community acquired
Current status: hospitalized

Case: 18-1743
Date: Sat 1 Sep 2018
MERS in Buraidah city: 61-year-old male living in Buraidah city, Qaseem region
Contact with camels: yes
Case classification: primary, community acquired
Current status: hospitalized

Communicated by:

[With the addition of these 2 newly confirmed cases, the total number of laboratory-confirmed cases of MERS-CoV infection reported by the Saudi MOH since September 2012 is now at 1873 (according to my spreadsheets), with at least 752 reported fatalities, bringing the case fatality rate to 40.1 percent.

A map of Saudi Arabia with provinces can be found at
HealthMap/ProMED-mail map:
Of note is that the MOH website has corrected the region for the case no. 18-1741 from Alzulfi to Riyadh region (see prior ProMED-mail post for discussion). - Mod.MPP]

[2] UK (England) ex Saudi Arabia, WHO
Date: Fri 31 Aug 2018
Source: WHO Emergencies preparedness, response, DON 31 Aug 2018 [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) - United Kingdom of Great Britain and Northern Ireland - 31 August 2018
On [22 Aug 2018], the International Health Regulations (IHR 2005) National Focal Point for the United Kingdom of Great Britain and Northern Ireland notified WHO about a laboratory-confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The patient is a resident of the Kingdom of Saudi Arabia who was visiting the United Kingdom of Great Britain and Northern Ireland.

The patient is a male aged between 80-89 years with underlying chronic medical conditions. He had no history of recent travel or contact with sick patients in the Kingdom of Saudi Arabia but had history of direct contact with camels before the onset of symptoms.

On [Thu 16 Aug 2018], while symptomatic, the patient travelled by aircraft from the Kingdom of Saudi Arabia to Manchester in the United Kingdom of Great Britain and Northern Ireland and then to Leeds by car. He received treatment while in isolation in Leeds before being transferred to a specialist infectious disease facility in Liverpool. The patient's condition has improved, and he continues to be in isolation.

Laboratory testing was performed by Public Health England (PHE) Birmingham laboratory, and the results were positive for MERS-CoV; these results were confirmed by the national reference laboratory.

This is the 5th case of MERS-CoV diagnosed in the United Kingdom of Great Britain and Northern Ireland, with the 4 previous cases diagnosed in 2012 and 2013.

The United Kingdom of Great Britain and Northern Ireland authorities promptly notified Saudi Arabian authorities on [22 Aug 2018].

Public health authorities in the United Kingdom of Great Britain and Northern Ireland have identified and are following up the contacts of the patient in the community, family, and healthcare facilities. Passengers on the flight within 3 rows of the case have been contacted and provided with information.

Public-health authorities in the Kingdom of Saudi Arabia have screened the patient's immediate family contacts for disease; all nasopharyngeal samples tested negative for MERS-CoV by PCR. The Animal Health Sector in the Ministry of Agriculture is investigating camel exposures in the Kingdom of Saudi Arabia.

The virus does not pass easily from person to person unless there is close contact, such as providing unprotected care to an infected patient. Infection with MERS-CoV can cause severe disease resulting in high rates of morbidity and mortality. Community-acquired human infections with MERS-CoV occurs from direct or indirect contact with infected dromedary camels. MERS-CoV can also transmit between humans through unprotected contact with an infected patient. So far, the observed non-sustained human-to-human transmission has occurred mainly in healthcare settings. Human-to-human transmission in healthcare settings can be stopped with adequate infection prevention and control measures.

The notification of an additional case does not change WHO's overall risk assessment for MERS-CoV. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and that sporadic cases will continue to be exported to other countries by individuals who have acquired the infection after exposure to infected animals or animal products (for example, following contact with dromedaries) or human cases (for example, in a healthcare setting). To date, no human MERS-CoV infections have been associated with Hajj.

WHO is working with the affected member states to follow up contacts. Additional infections identified as part of the ongoing public-health response to this imported case will not change the overall public health risk, which is low.

WHO continues to monitor the epidemiological situation and conduct risk assessments based on the latest available information.

Based on the current situation and available information, WHO encourages all member states to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns. WHO recommends the collection of exposure information, including recent travel history, contact with dromedary camels, and visits to healthcare facilities in countries where MERS-CoV is circulating.

General hygiene measures, such as regular handwashing before and after touching animals and avoiding contact with sick animals should be adhered to. Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in healthcare facilities. It is not always possible to identify patients with MERS-CoV early; as with other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, healthcare workers should consistently apply standard precautions with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with acute respiratory infection symptoms; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol-generating procedures.

Community and household awareness of MERS-CoV and its prevention measures in the home may reduce household transmission and prevent community clusters.

People with underlying illness such as diabetes, renal failure, or chronic lung disease or who are immunocompromised are considered to be at high risk of severe disease from MERSā€CoV infection. These people should avoid close contact with animals, particularly camels.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions.

As of July 2018, the total global number of laboratory-confirmed cases of MERS-CoV reported since 2012 is 2241, including 1865 cases that have been reported from the Kingdom of Saudi Arabia. Among all cases, at least 795 MERS-CoV-associated deaths have occurred.

The global number reflects the total number of laboratory-confirmed cases reported to WHO under the IHR (2005) to date. The total number of reported deaths includes deaths that WHO is aware of to date through follow-up with affected member states. Both may be an underestimate of the true number of infections and deaths.

Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[New information contained in the above WHO update is confirmation the case is an octogenarian male with a history of contact with camels in the 14 days preceding onset of illness. Presumably the identified airline contacts (seated up to 3 rows from the case) have not been identified to have MERS-CoV infected, as the 14-day period following exposure has now been completed. - Mod.MPP

HealthMap/ProMED-mail maps:
England, United Kingdom:
Riyadh Province, Saudi Arabia:
Al Qassim Province, Saudi Arabia:]

See Also
MERS-CoV (30): Saudi Arabia (RI) new case 20180830.5998414
MERS-CoV (29): UK (England) ex Saudi Arabia, Risk Assessment ECDC: 20180830.5996187
MERS-CoV (28): UK (England) ex Middle East, RFI, corr 20180824.5985568
MERS-CoV (28): UK (England) ex Middle East, RFI 20180823.5983079
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