# 9603
As the total number of confirmed MERS cases closes in on 1,000 the ECDC has produced their 13th update on the MERS coronavirus, and the risks (low at this time) it may pose to the EU. As we’ve come to expect, along with this rapid risk assessment we also get a detailed epidemiological review of cases, discussing what we know – and what we don’t.
The chart above shows the major surge in cases recorded during the spring of 2014, and since we don’t know all of the factors behind that huge spike in cases, there are obviously concerns we could see a repeat performance this spring as well.
While dated January 15th, this report appears to have only recently been uploaded to the ECDC website. I’ve included the summary and some excerpts from the report, but use the link to download the entire PDF.
Main conclusions and recommendations
Since April 2012 and as of 11 January 2015, 972 cases of Middle East respiratory syndrome coronavirus (MERSCoV) have been reported by local health authorities worldwide, including 394 deaths.
The incidence of MERS-CoV cases shows a decrease after the surge in October 2014, and the majority of MERS-CoV cases are still reported from the Arabian Peninsula, mainly from Saudi Arabia.
The source of MERS-CoV infection and the mode of transmission have still not been confirmed.
Taking into account the latest developments with respect to the Middle East respiratory syndrome coronavirus
(MERS-CoV), ECDC’s conclusion in this latest update continues to be that the assessed risk to the EU posed by the outbreak of MERS-CoV is low.
There is a continued risk of cases presenting in Europe following exposure in the Middle East and international surveillance for MERS-CoV cases remains essential. Although importation of MERS-CoV cases to the EU remains possible, the risk of sustained human-to-human transmission in Europe remains very low.
Sensitisation of healthcare staff to MERS-CoV is prudent, not only for timely detection purposes, but also in order to ensure rapid implementation of infection control measures.
Conclusions
The overview of this virus, its epidemiology, clinical features, transmission and diagnostics as well as relevant
public health measures are presented in the ECDC factsheet [8]. The source of MERS-CoV infection and the mode of transmission have still not been confirmed. Dromedary camels are a host species for the virus, and many of the primary cases in clusters have reported direct or indirect camel exposure. However, close contact with infectious camels does not always seem to result in human infections [12]. In addition, despite evidence of seropositive camels in several African countries and PCR-positive camels originating from Pakistan, no autochthonous cases arising from presumed camel contacts have been reported from outside the Middle East. This might be due to lack of diagnostic capacity in these countries. Serological screening kits are now also commercially available for both humans and camels.
The increase of human MERS-CoV cases in October 2014 is not explained by the calving or weaning of camel calves as it does not coincide with the calving and weaning seasons. The latest case reports do not suggest any link with participating in the Hajj or Umrah either. Similar to the upsurge in case numbers in April/May 2014, the increase in case numbers in Saudi Arabia in the autumn of 2014 could be linked to specific nosocomial outbreaks in Taif and Riyadh.In 2013, WHO proposed a multi-country case-control study to assess the risk factors associated with infections of primary cases, which the affected countries agreed to embark on [13]. Results of such a study could be highly informative for disease control purposes.
The incidence of MERS-CoV cases shows a decrease after the surge in October 2014, and the majority of MERS CoV cases are still reported from the Middle East, mainly from Saudi Arabia. All cases have epidemiological links to the outbreak epicentre. The increase shows that the MERS-CoV continues to circulate, particularly in the Middle East and the risk for transmission is greatest for people in this area.
A large surge in infections seen in the spring of 2014 was mainly due to an outbreak in Jeddah, but driven by an increase in primary infections [14]. These events may be repeated in spring 2015, and therefore public health authorities in the epicentre are actively preparing appropriate responses. In Saudi Arabia, the response activity has recently been decentralised from a national command and control centre to regional health departments [15].
Also in the EU/EEA, public health authorities are prepared for timely detection and appropriate treatment of cases among returning travellers, should the need arise. Sensitisation of first-line healthcare staff to the fact that MERS CoV is still circulating in the Middle East is prudent, not only for timely detection purposes, but also in order to ensure rapid implementation of infection control measures.
Taking into account the latest developments with respect to the Middle East respiratory syndrome coronavirus
(MERS-CoV), ECDC’s conclusion in this latest update continues to be that the assessed risk to the EU posed by the outbreak of MERS-CoV is low.
There is a continued risk of cases presenting in Europe following exposure in the Middle East and international surveillance for MERS-CoV cases remains essential.
Although importation of MERS-CoV cases to the EU remains possible, the risk of sustained human-to-human transmission in Europe remains very low.
You’ll note the diplomatic reminder in the Conclusion section of this report on the value of having a case-control study, an important piece of epidemiological analysis that has been long promised by the Saudi MOH (see June 2014 KSA Announces Start To Long-Awaited MERS Case Control Study), but which has yet to be delivered.
