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As part of their larger overall weekly Communicable Disease Threats report, the ECDC today has updated their assessment of the MERS outbreak in the Middle East.
Middle East respiratory syndrome- coronavirus (MERS CoV) – Multistate
Opening date: 24 September 2012 Latest update: 17 April 2014
Epidemiological summarySince April 2012 and as of 18 April 2014, 275 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 98 deaths and 64 healthcare workers. The following countries have reported MERS-CoV cases:
Saudi Arabia: 212 cases / 72 deaths
United Arab Emirates: 33 cases / 9 deaths
Qatar: 7 cases / 4 deaths
Jordan: 4 cases / 3 deaths
Oman: 2 cases / 2 deaths
Kuwait: 3 cases / 1 death
UK: 4 cases / 3 deaths
Germany: 2 cases / 1 death
France: 2 cases / 1 death
Italy: 1 case / 0 death
Tunisia: 3 cases / 1 death
Malaysia: 1 case / 1 death
Philippines: 1 case / 0 deathFourteen cases have been reported from outside the Middle East: the UK (4), France (2), Tunisia (3), Germany (2), Italy (1), Malaysia (1) and Philippines (1). In France, Tunisia and the UK, there has been local transmission among patients who had not been to the Middle East, but had been in close contact with laboratory-confirmed or probable cases. Person-to-person transmission has occurred both among close contacts and in healthcare facilities.
In the first 18 days of April 2014, 57 cases (21% of total cases) have been reported, 29 of whom are healthcare workers (51%) and 21 are asymptomatic cases. In the United Arab Emirates, a cluster of 14 healthcare workers (including one case exposed in UAE and reported by the Philippines) has been reported during the past week. They all had had contact with a previously reported case, who died on 10 April 2014. Eight of the cases had mild symptoms and six were asymptomatic.
In Saudi Arabia, during the past week, 30 cases have all occurred in Jeddah, including 11 healthcare workers; five cases were fatal and eight were asymptomatic.
The first cases reported in Asia have occurred in people returning from the Middle East:
ECDC assessment
The source of MERS-CoV infection and the mode of transmission have not been identified, but the continued detection of cases in the Middle East indicates that there is an ongoing source of infection in the region. Dromedary camels are likely an important host species for the virus, and many of the primary cases in clusters have reported direct or indirect camel exposures. Almost all of the recently reported secondary cases, many of whom are asymptomatic or have only mild symptoms, have been acquired in healthcare settings. There is therefore a continued risk of cases presenting in Europe following exposure in the Middle East and international surveillance for MERS-CoV cases is essential. An international case-control study has been designed and proposed by WHO. Results of this or similar epidemiological studies to determine the initial exposures and risk behaviours among the primary cases are urgently needed.
The risk of secondary transmission in the EU remains low and can 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. The case detected in Malaysia last week had participated in the muslim pilgrimage Umrah. However, more details are needed on possible and suspected exposure events and it is possible that these cases were also infected when visiting healthcare facilities in the region.
The Malaysian authorities have asked all passengers travelling on the flights with the case detected in Malaysia on 29 March to be screened for health complaints.
The Philippines authorities have asked all passengers travelling with the Filipino case detected on 15 April to be screened for signs and symptoms of MERS-CoV infection, while the department of health is also actively contact tracing passengers.
