#18,974
Details on the two imported MERS-CoV cases reported by France earlier this week remain scant, with no additional press releases from the French MOH, although a brief report yesterday in the BMJ identified the two patients as being men in their 70s, who are both reportedly in stable condition.
Their itinerary, onset dates, number of close contacts, and likely route of exposure have not been released.
Yesterday the ECDC released two reports on this incident: 1) a brief synopsis in their Communicable disease threats report (Week 49), and 2) an Epidemiological Update, neither of which shed light on the above mentioned questions.
Both, however, stress that while the risk to the EU is currently low, `. . sporadic MERS cases in travellers returning to the EU/EEA can be expected'. Therefore:
European public health authorities should remain vigilant, continue surveillance of acute respiratory infections and maintain preparedness for travel-related MERS-CoV cases entering the EU/EEA.
I've reproduced the Epidemiological Update below. I'll return with a brief postscript after the break.
Two cases of Middle East respiratory syndrome (MERS) in travellers returning to France from the Arabian Peninsula
Epidemiological update
5 Dec 2025
On 3 December 2025, the French Ministry of Health reported two imported human Middle East respiratory syndrome (MERS) cases with travel history to the Arabian Peninsula. The two affected individuals participated in the same group trip. No secondary cases have been identified so far.
French authorities are implementing response measures and monitoring the situation. (More information from the French Ministry of Health)
European public health authorities should continue surveillance of acute respiratory infections and maintain preparedness for potential travel-related MERS cases entering the EU/EEA. Information about the recent cases, case definitions and diagnostic approaches should be shared with clinicians to maintain increased awareness for early identification, isolation and diagnosis of possible MERS cases. Adherence to strict infection control protocols during contact with patients that may have a Middle East respiratory syndrome coronavirus (MERS-CoV) infection – including hand hygiene and respiratory measures – is critical to prevent further spread of the virus in healthcare settings.
Countries should also advise travellers returning from areas where MERS-CoV may be circulating to seek medical attention if they develop a respiratory illness with fever and cough or diarrhoea during the two weeks following their return and to disclose their recent travel history to their healthcare provider. Travellers to the Arabian Peninsula are also advised to avoid contact with dromedary camels and consumption of camel products. When visiting markets or places where dromedary camels are present, strict hygiene measures should be followed. These include hand hygiene before and after touching animals and avoiding any contact with sick animals. Further information can be found in the World Health Organization’s MERS-CoV factsheet.
Although sporadic MERS cases in travellers returning to the EU/EEA can be expected, the probability of sustained human-to-human transmission among the general population in Europe remains very low and the impact of the disease in the general population is considered low. The current MERS situation poses a low risk to the EU/EEA, and recommendations from the Rapid Risk Assessment published by ECDC on 29 August 2018 still apply.
ECDC published a technical report, ‘Health emergency preparedness for imported cases of high-consequence infectious diseases’, in October 2019 that is still useful for EU/EEA countries wishing to assess their level of preparedness for a disease such as MERS. ECDC also published ‘Risk assessment guidelines for infectious diseases transmitted on aircraft (RAGIDA) – Middle East respiratory syndrome coronavirus (MERS-CoV)’ on 22 January 2020.
MERS-CoV is a zoonotic virus transmitted mostly from infected dromedary camels and via consumption of raw or undercooked camel products, including milk. Human-to-human transmission is possible, with documented events occurring mostly in hospital settings. Since April 2012, and as of 1 December 2025, a total of 2 640 cases of MERS, including 958 deaths, have been reported by health authorities worldwide. The majority of these have been reported in the Middle East. Excluding these two recent cases, the latest imported case in Europe occurred in 2018.
While the number of reported MERS-CoV cases from the Middle East has plummeted in recent years, so too have surveillance and reporting. A decade ago - flawed as it sometimes was - Saudi Arabia provided daily MERS-CoV updates.
Several times, however, their MOH went dark for months at a time on the subject (see 2018's The Saudi MOH Breaks Their Silence On MERS-CoV).
Regular MERS reporting ended in 2020 with the arrival of COVID, but starting in 2022, KSA announced they would report MERS-CoV cases on a bi-annual basis.
To be fair, we don't hear much from other nations on the Arabian peninsula, where MERS-CoV has also been been detected in both camels and humans. And it seems likely that cases are being missed in North and Central Africa as well (see EID Journal: Geographic Distribution of MERS-CoV among Dromedary Camels, Africa).
Over the past decade we've looked at many of the challenges of MERS-CoV surveillance, including:
And in 2018 - in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at a highly critical review of the screening methods used by the Saudis for selecting patients for MERS testing. As a result, the official total of 2,640 cases is highly suspect.
Also last June, in JEGH: Epidemiological Characteristics of MERS-CoV Human Cases, 2012- 2025, we looked at the changing epidemiology of MERS-CoV cases since 2012, as well as substantial gaps in our current understanding of the disease.Last August, in IJID Editorial: Al-Tawfiq on Global Epidemiology and Public Health Challenges of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), we looked at what may be the most challenging aspect of MERS detection; asymptomatic or mildly symptomatic cases.
Prior to the emergence of COVID in late 2019, MERS-CoV was viewed as being the top coronavirus pandemic threat (see 2017's A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia), with its R0 (basic reproduction number) briefly flirting with 1.0.
Whether MERS-CoV will re-emerge as a global health threat remains unknown, but it continues to circulate - and evolve - on both the Arabian Peninsula and in Africa.
We ignore its potential at considerable risk.
