#19,378
While it doesn't get near the attention it did before COVID, MERS-CoV continues to circulate in dromedary camels in the Middle East, occasionally spills over into humans, and is likely under reported.
In 2025, the WHO released 3 MERS-CoV DON reports (see here, here, and here), and last December, France reported 2 Travelers Returning From Arabian Peninsula Diagnosed with the MERS-CoV virus.MERS-CoV also continues to evolve, which raises concerns over its future impact (see Health Sci Rpts (Narrative Review): Pathogenicity and Potential Role of MERS-CoV in the Emergence of “Disease X”).
This year has been somewhat quieter, with the first WHO update of 2026 published just last week (October 15th), which chronicles 8 cases reported by Saudi Arabia since last December.
Of note - while the WHO states `Humans contract MERS-CoV through direct or indirect contact with dromedary camels, the virus’s natural host and zoonotic reservoir.' - 6 of the 8 cases reported no known contact with camels or camel products.
This is not a new trend; in 2025 more than half of the cases reported by KSA listed no known contact with camels or camel products, and this has been frequently reported in the past.
Exactly how these people are contracting the virus remains unclear.
First some excerpts from the latest DON report, after which I'll have a postscript.
Middle East respiratory syndrome coronavirus - Kingdom of Saudi Arabia
15 October 2026
Situation at a glance
Between 1 January and 5 October 2026, the Kingdom of Saudi Arabia reported eight laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, including one death. Cases were detected across six locations: Al Jouf (1), Arar (1), Hafr Al-Batin (1), Riyadh (2), Tabuk (1) and Taif (2). No epidemiological links were identified between any of the cases. All eight cases were symptomatic, most commonly presenting with fever (6/8), dyspnea (5/8), and cough (4/8). None were health and care workers. Infection was confirmed by RT-PCR testing. MERS is a zoonotic viral respiratory disease for which dromedary camels serve as the primary animal reservoir and two cases reported direct contact with camels while six reported no known camel exposure. Seven of eight cases had underlying comorbidities, recognized risk factors for severe MERS-CoV disease. The cases appear to represent sporadic infections related to zoonotic spillover rather than a single outbreak cluster.
Description of the situation
Between 1 January and 5 October 2026, a total of eight cases of MERS-CoV, including one death, was reported from six locations in the Kingdom of Saudi Arabia. Of the eight reported cases, five occurred among persons aged 70 years and older, two among adults aged 50–59 years, and one among an adult aged 30–39 years. Seven cases had underlying comorbidities, two reported direct camel contact, and one death was reported in an older adult (>65 year old) with comorbidities. There was no known epidemiological link identified among cases.
Case 1: A male aged 50–59 years, with comorbidities, from Al Jouf developed symptoms on 14 March 2026. He reported no known contact with camels or camel products. The patient was hospitalized on 17 March and laboratory confirmation of MERS-CoV infection was obtained by RT-PCR on 19 March.
Case 2: A male aged ≥70 years, with comorbidities, from Taif developed symptoms on 18 April 2026. He reported no known contact with camels or camel products. The patient was hospitalized on the same day, and laboratory confirmation was obtained on 22 April. He subsequently died as a result of the illness.
Case 3: A male aged ≥70 years, with comorbidities, from Hafr Al-Batin developed symptoms on 20 May 2026. He reported direct contact with camels. The patient was hospitalized on 26 May and laboratory confirmation was obtained on 27 May.
Case 4: A female aged ≥70 years, with comorbidities, from Riyadh developed symptoms on 31 July 2026. No known exposure to camels or camel products was reported. She was hospitalized on 3 August and laboratory confirmation was obtained on 8 August.
Case 5: A male aged 50–59 years, with comorbidities, from Tabuk developed symptoms on 20 August 2026. He reported no known contact with camels or camel products. He was hospitalized on 23 August and laboratory confirmation was obtained by RT-PCR on 24 August.
Case 6: A male aged 30–39 years, with no known comorbidities, from Riyadh developed symptoms on 14 August 2026. He reported no known contact with camels or camel products. He was hospitalized on 20 August and laboratory confirmation was obtained on 23 August.
Case 7: A male aged ≥70 years, with comorbidities, from Taif developed symptoms on 11 September 2026. He reported no known contact with camels or camel products. He was hospitalized on 17 September and laboratory confirmation was obtained on 19 September.
Case 8: A male aged 60–69 years, with comorbidities, from Arar developed symptoms on 20 September 2026. He reported direct contact with camels. He was hospitalized on 20 September and laboratory confirmation was obtained on 21 September.
(SNIP)
WHO risk assessment
MERS is a zoonotic viral respiratory disease caused by MERS-CoV, for which dromedary camels serve as the primary animal reservoir. Human infection can range from asymptomatic or mild illness to severe disease and death. Human infections continue to occur through direct or indirect exposure to infected dromedaries or their products, while limited human-to-human transmission has been documented, primarily among close contacts and in healthcare settings. Sustained community transmission has not been observed. No licensed vaccine for MERS-CoV exists to date.
As of 5 October 2026, WHO had been notified of 2643 laboratory-confirmed MERS cases globally, including 965 deaths, since the virus was first identified in 2012. The majority of cases (84%; 2232 cases and 870 deaths) have been reported from Saudi Arabia. These figures likely underestimate the true number of infections since mild and asymptomatic cases may remain undetected/unreported, while the reported case fatality of ratio of 37% may overestimate mortality among infections.
Although the number of reported MERS cases has declined substantially since 2020, MERS-CoV continues to circulate in dromedary camel populations in the Middle East and African regions and continues to cause sporadic human infections. The observed decline in reported MERS cases, in particular during the COVID-19 pandemic emergency phase, is thought to be a result of pandemic-related IPC measures that also limited human-to-human transmission of MERS-CoV, as well as behavioral changes during the pandemic. Any role of potential cross-reactive immunity from SARS-CoV-2 infection and/ or vaccination remains in need of further investigation. Other hypotheses—such as reduced surveillance, viral attenuation, or decreased circulation in camel populations—are not supported by current evidence.
WHO expects additional sporadic MERS cases to occur in countries where the virus circulates in camels and anticipates that travel-associated exportation of cases will continue. Delays in detection remain possible due to the clinical presentation of MERS being similar with other respiratory infections, including influenza and COVID-19. Numerous outbreaks in KSA and the Republic of Korea have demonstrated that primary cases can result in substantial secondary transmission, particularly in healthcare settings and through importation of travel related cases.
The notification of the recent cases in Saudi Arabia does not change WHO's overall risk assessment - the risk remains moderate at both the regional and global levels, reflecting the continued occurrence of sporadic zoonotic infections, the potential for healthcare-associated outbreaks and international exportation of cases, in the absence of sustained human-to-human transmission.
WHO continues to monitor the epidemiological situation through routine surveillance and reporting under the International Health Regulations (IHR 2005) and conducts ongoing risk assessments using available epidemiological and virological information.
In June of 2025 we looked at an editorial in Journal of Epidemiology & Global Health on the importance of healthcare preparedness and surveillance (see Al-Tawfiq & Memish On Recurrent MERS-CoV Transmission in Saudi Arabia), with an emphasis on identifying asymptomatic carriers.
Two months later we reviewed an IJID Editorial: Al-Tawfiq on Global Epidemiology and Public Health Challenges of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - which looked again at what may be the most challenging aspect of MERS detection; asymptomatic or mildly symptomatic cases.
Although MERS-CoV clearly isn't ready for prime time, each new zoonotic spillover from camels - or cryptic transmission - is another opportunity for the virus to better adapt to a human host.
Which is why we need better MERS-CoV surveillance and reporting, both in the Middle East, and in Africa (see EID Journal: Geographic Distribution of MERS-CoV among Dromedary Camels, Africa).
