Credit ECDC Rapid Risk Assessment On MERS-CoV
# 7815
The ECDC has just released their 7th Rapid Risk Assessment on the MERS Coronavirus, which looks at the changing epidemiology of the virus, provides travel advice for the upcoming Hajj, and offers their most current risk assessment on the spread of this virus into the European Union.
It’s a 17-page document, and as we’ve come to expect from the ECDC, represents a comprehensive collection of data, charts, and maps. You’ll undoubtedly want to download and read it in its entirety, as the data presented deserves more than just a cursory look, but I’ve included brief excerpts from the assessment’s conclusions and Travel Advice:.
Conclusions
The risk of importation of MERS-CoV to the EU is expected to continue, and it is possible that the risk of importation will increase as a result of increasing transmission in Saudi Arabia and an increasing number of visitors from the EU to Saudi Arabia during the Hajj from 13 to 18 October 2013. The precise risk of importation is difficult to estimate as long as the source of the virus and the mode of transmission remain unknown.
No cases were reported outside the Middle East since May.
The risk of secondary transmission in the EU remains low and could be further reduced through screening patients presenting which show suggestive respiratory symptoms and are linked to travel to the Middle East in the two weeks prior to presenting; the strict implementation of infection prevention and control measures for patients under investigation would be equally positive.
Limited human-to-human transmission has occurred in several clusters, among household or close contacts, and within healthcare facilities, both in Europe and in the Middle East [10-13, 24-26, 38]. The Al-Ahsa outbreak, with 23 confirmed cases in four facilities, the transmission in France between two people who shared a room and toilet, and the transmission in London from an intubated case to a visiting relative, indicate a significant risk for nosocomial transmission. The Al-Ahsa cluster is a significant event, which could have been caused by lack of appropriate infection prevention measures in the health facilities but also raises concerns about the possibility of a ‘superspreading’ event, a phenomenon that played an important role for the spread of the SARS-CoV pandemic.
Probably due to enhanced contact tracing activities, the proportion of cases associated with healthcare settings has increased substantially and now accounts for 24% of all reported cases. However, with the exception of the cluster in Al-Ahsa, the number of confirmed secondary cases per cluster has remained low, and there is no convincing evidence of the virus becoming more infective over time.
Although studies indicate that animals are the probable source of infection or intermediate hosts, the virus
reservoir remains unknown.The transmission pattern in Saudi Arabia, with many sporadic cases distributed over a large geographical area, points to infrequent introductions of the virus from a continuous non-human source However, no epidemiologic studies have been published that document animal exposure investigations.
Travel advice
ECDC endorses the WHO travel advice for MERS-CoV, which does not impose any travel or trade restrictions. In view of the forthcoming Hajj (13−18 October 2013) and the large number of European Muslims who visit Saudi Arabia at all times of the year, Member States should consider disseminating specific advice through dedicated travel agencies and religious organisations.
Travellers to the Middle East should:
- avoid contacts with animals and their waste products;
- limit contacts with others and practise cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands) if they develop respiratory illness;
- avoid close contact with sick people, especially with those suffering from acute respiratory infections;
- practise good hand hygiene, especially if respiratory symptoms develop and after direct contact with ill people or their environments.
Travellers from the EU who plan to visit Saudi Arabia for the Umrah and Hajj pilgrimage should consult the recommendations made by the Saudi Ministry of Health. The Health regulations for travellers to Saudi Arabia regarding MERS-CoV [54] recommends that the elderly (above 65 years of age) and those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency (congenital and acquired), malignancy and terminal illnesses, pregnant women and children (under 12) should postpone the Hajj and Umrah for their own safety.
General travel health advice, including avoiding unsafe water, undercooked meats, and raw fruits and vegetables unless freshly peeled and washed, remain important for travel in the Middle East.
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