Middle East respiratory syndrome coronavirus – Saudi Arabia

Between 12 March and 31 July 2021 , the National IHR Focal Point of Saudi Arabia reported four additional cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, including one associated death. The cases were reported from three regions including Riyadh (two cases), Hafar Albatin (one case), and Taif (one case). One  death was also reported from a previously reported case  (Case #7, please see Disease outbreak news published on 14 April ) who died on 20 March. Since 2012, Saudi Arabia has reported 2178 confirmed MERS-CoV cases with 810 deaths.

 The link below provides details of the four reported cases

• MERS-CoV cases reported from 12 March through 31 July 2021

Between September 2012 until 31 July 2021, a total of 2578 laboratory-confirmed cases of MERS-CoV and 888 associated deaths were reported globally to WHO under the International Health Regulations (IHR 2005). The majority of these cases have occurred in the Arabian Peninsula, with one large outbreak outside this region in the Republic of Korea, in May 2015, when 186 laboratory-confirmed cases (185 in Republic of Korea and 1 in China) and 38 deaths were reported. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected Member States.

Middle East respiratory syndrome (MERS) is a viral respiratory infection of humans and dromedary camels which is caused by a coronavirus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Infection with MERS-CoV can cause severe disease resulting in high mortality. Approximately 35% of patients with MERS have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS-CoV may be missed by existing surveillance systems and until more is known about the disease, the case fatality rates are counted only amongst the laboratory-confirmed cases.

Humans are infected with MERS-CoV from direct or indirect contact with dromedaries who are the natural host and zoonotic source of the MERS-CoV infection. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred among close contacts and in health care settings. Outside of the healthcare setting there has been limited human-to human transmission.

The notification of those additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries, or animal products (for example, consumption of  raw camel’s milk), or in a healthcare setting.

WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information. However, with the current COVID-19 pandemic, the testing capacities for MERS-CoV have been severely affected in many countries since most of the resources are redirected to prevent and control the current COVID-19 pandemic. The Ministry of Health of Saudi Arabia is working to increase the testing capacities for better detection of MERS-CoV infections.

Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections and to carefully review any unusual patterns.

Human-to-human transmission in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing infection, prevention and control (IPC) measures, therefore, IPC measures are critical to prevent the possible spread of MERS-CoV between people in health care facilities. Healthcare workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures or in settings where aerosol generating procedures are conducted.

Early identification, case management and isolation of cases, supported quarantine of contacts, together with appropriate infection prevention and control measures and public health awareness can prevent human-to-human transmission of MERS-CoV.

MERS-CoV appears to cause more severe disease in people with underlying chronic medical condition such as diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

• Middle East respiratory syndrome, situation update as of June 2021
• Middle East respiratory syndrome coronavirus (MERS-CoV)
• Middle East respiratory Syndrome Outbreak Toolbox
• MERS outbreak in the Republic of Korea, 2015