It’s been just over a week since the last major ECDC Rapid Risk Assessment on the MERS Coronavirus was issued (see MERS-CoV: ECDC Rapid Risk Assessment – September), and since then six more cases have been added to the ECDC’s list, all hailing from Saudi Arabia.
While not exactly an explosion in cases - the steady trickle of new reports, the similarities between MERS-CoV and the SARS virus of a decade ago, and the sizable gaps in our knowledge over the source and potential spread of this virus – have all contributed to a well-found wariness among public health officials around the globe.
As part of their weekly Communicable Disease Threats publication, ECDC published the following epidemiological summary yesterday.
Opening date: 24 September 2012 Latest update: 3 October 2013
As of 3 October 2013, there have been 139 laboratory-confirmed cases of MERS-CoV worldwide, including 60 deaths.
All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. Saudi Arabia has reported 117 symptomatic or asymptomatic cases including 49 deaths, Jordan two cases, who both died, United Arab Emirates five cases, including one fatality and Qatar three cases, including two deaths. Twelve cases have been reported from outside the Middle East: in the UK (4), Italy (1), France (2), Germany (2) and Tunisia (3).
In France, Tunisia and the United Kingdom, there has been local transmission among patients who have not been to the Middle East but have been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities. However, with the exception of a possible nosocomial outbreak in Al-Ahsa, Saudi Arabia, secondary transmission has been limited. Sixteen asymptomatic cases were reported by Saudi Arabia and two by the UAE. Seven of these cases were healthcare workers.
The Ministry of Health of Saudi Arabia updated its Health Regulations for travellers to Saudi Arabia for the Umrah and Hajj pilgrimage regarding MERS-CoV and now recommends that the elderly, those with chronic diseases, pilgrims with immune deficiency, malignancy and terminal illnesses, pregnant women and children coming for Hajj and Umrah this year should postpone their journey.
WHO published a travel advice on MERS-CoV for pilgrims on 25 July 2013.
On 18 September WHO has issued an interim recommendation to laboratories and stakeholders involved in laboratory testing for Middle East respiratory syndrome coronavirus (MERS-CoV).
The WHO third meeting of the Emergency Committee was held by teleconference on, 25 September 2013. The Committee concluded that it saw no reason to change its advice to the Director-General. Based on the current information, and using a risk-assessment approach, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.
The continued detection of MERS-CoV cases in the Middle East indicates that there is an ongoing source of infection present in the region. The source of infection and the mode of transmission have not been identified.There is therefore a continued risk of cases occurring in Europe associated with travel to the area. Surveillance for cases is essential, particularly with expected increased travel to Saudi Arabia for the Hajj in October.
The risk of secondary transmission in the EU remains low and could 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.
While the risks of seeing secondary transmission outside of the Middle East are considered low at this time, with nearly two million international visitors expected for the Hajj this month, there are legitimate worries that some of these visitors could carry the virus home with them. Public health agencies around the globe are ramping up surveillance and testing in order to detect, and isolate, any cases as soon as possible.
Accordingly, we’ve seen a steady stream of guidance documents prepared and released by the World Health Organization, the ECDC, and the CDC regarding surveillance, testing, isolation of patients, and treatment of cases over the past couple of months, including:
This latest ECDC Communicable Disease Threats publication also summaries outbreaks of Pertussis, Poliomyelitis, West Nile Virus, and Dengue.