The ECDC has released a new epidemiological update on the MERS-CoV outbreak on the Arabian peninsula in light of yesterday’s announced imported case in Austria, and the Hajj which occurs during the first week of October.
Between concerns over Ebola, MERS-CoV, and the anticipated seasonal uptick in avian flu cases that arise during the winter and spring, public health officials expect to have their hands full over the next few months.
While the number of new MERS case announcements remains fairly low, the ECDC is emphasizing epidemic intelligence work during, and after the Hajj in order to detect any potential cases imported into the EU.
On 29 September, the Austrian Department of Health reported a confirmed case of MERS-CoV infection in a citizen of the Kingdom of Saudi Arabia recently arrived in Austria. The patient is isolated in a medical facility in Vienna. Tracing of contacts is currently underway.
Since the last ECDC rapid risk assessment of 21 August and as of 30 September 2014, 31 additional cases have been reported in Saudi Arabia. Of these 31, 19 are retrospective cases with date of onset prior to 3 June 2014 reported on 18 September 2014.
Overall, 887 laboratory-confirmed cases of MERS-CoV have been reported to public health authorities worldwide, including 352 deaths (Figure 1). Most of the cases have occurred in the Middle East (Saudi Arabia, United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Egypt, Yemen, Lebanon and Iran) (Table 1). All cases reported outside of the Middle East have had recent travel history to the Middle East or contact with a case who had travelled from the Middle East (Figure 2).
In September 2014, the World Health Organization (WHO) revised the interim recommendations for laboratory testing for MERS-CoV.
Case definitions and surveillance guidance updated in July 2014 are now available on the WHO website.
On 22 September 2014, the Saudi Ministry of Health published a revised version of the MERS-CoV case definition.
The Hajj is taking place between 1 and 6 October. Those travelling from the EU to Saudi Arabia for the Hajj pilgrimage should consult the recommendations made by the Saudi Ministry of Health under Health Regulations for travellers to Saudi Arabia, which provide a comprehensive overview of the measures implemented by the local health authorities in the preparation of this event attended by over 3 million pilgrims.
The number of cases reported in the last months has decreased in Saudi Arabia, likely reflecting decreased transmission of the virus in the community compared to the previous year. However, general travel health advice, including avoiding unsafe water, undercooked meats, and raw fruits and vegetables unless freshly peeled and washed, remain important for those travelling in the Middle East.
ECDC will enhance the epidemic intelligence activities during and after the Hajj to detect possible events posing a threat to Europe. Currently the advice presented in the last ECDC rapid risk assessment remain valid.
Figure 1. Distribution of confirmed cases of MERS-CoV reported September 2012–30 September 2014, by date and reporting country (n=887)