On 2nd September 2015, World Health Organization’s (WHO) Emergency Committee met for the tenth time and announced that the Middle East respiratory syndrome (MERS) outbreak was not a Public Health Emergency of International Concern (PHEIC). Based on current information, they indicated that the situation remains serious in terms of public health impact. Significant efforts are on-going to strengthen infection prevention and control measures.(1)
As indicated in WHO Statement on the tenth meeting of the IHR Emergency Committee on MERS, there is an update in terminology. The term “Middle East respiratory syndrome”, or MERS, refers to the disease caused by the MERS coronavirus. MERS-CoV will continue to be used for the virus itself.
The majority of the MERS cases continue to be reported from the Middle East, and specifically from Saudi Arabia and Jordan. Given the substantial number of people travelling between the Middle East and EU countries, sporadic imported cases to Europe can be expected. In addition, due to an anticipated increase in travel to Saudi Arabia related to Umra and the Hajj (September 14th to 28th 2015), vigilance regarding MERS is to remain high. WHO has issued specific travel advice on MERS for pilgrimages.(2) See also HPSC website for travel advice.
Persons returning from the Middle East who develop symptoms such as cough, fever, shortness of breath, or diarrhoea within 14 days of returning should seek urgent medical attention, and tell the doctor that they have recently returned from the Middle East. Until more is understood about MERS, people with diabetes, renal failure, chronic lung disease and immunosuppression are considered at high risk of severe disease with MERS-CoV infection. The HPSC website has guidance on the investigation and public health management of possible cases and contacts of MERS.
When compared to previous years, the increase in reported MERS cases in August was unexpected and is mainly explained by a large, on-going, nosocomial outbreak in Riyadh linked to one healthcare facility. The extent to which other healthcare facilities in Riyadh are affected is unknown, as is the number of asymptomatic individuals who may be infected with MERS-CoV. The role of hospitals as amplifiers of MERS-CoV infection is now well known, making the strict and timely application of comprehensive infection prevention and control measures all the more imperative.
Sporadic, imported cases can be expected in EU/EEA Member States, and are associated with a risk of nosocomial spread. This highlights the need for awareness among healthcare workers, early detection through functioning testing algorithms, preparedness planning and stringent infection control precautions. Advice previously issued for travellers, including pilgrims, and healthcare workers remains valid. The European Centre for Disease Prevention and Control (ECDC) published a risk assessment on MERS on August 27th 2015.(3) The full ECDC risk assessment is available on the ECDC website.
Recommendations from the WHO
In light of the above, as a general precaution, travellers to the Middle East who visit farms, markets, barns or other places where camels are present should practise general hygiene measures as follows:
- Regular hand washing after touching animals,
- Avoid touching eyes, nose or mouth with hands
- Avoid contact with sick animals.
The consumption of raw or undercooked animal products including milk and meat carries a high risk of infection from a variety of organisms that might cause human illness. Animal products (including camel milk) processed appropriately through proper cooking or pasteurisation are safe for consumption but should be handled with care to avoid cross-contamination with uncooked food.
Epidemiological Update
Since April 2012 and as of 17 September 2015, 1,595 cases of MERS have been reported by local health authorities worldwide, including 606 deaths. ECDC publish epidemiological updates.(4)
See also:
WHO: Coronavirus infections
ECDC: Coronavirus infections
HPSC: Coronavirus infections
Mary O'Riordan, HPSC
References
1. World Health Organization. WHO statement on the Tenth Meeting of the IHR Emergency Committee concerning MERS. 2nd September 2015. Available here.
2. World Health Organization. Travel advice on MERS-CoV for pilgrimages. July 14th 2015. Available here.
3. European Centre for Disease Prevention and Control. Updated rapid risk assessment. Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV). 20th update, 27th August 2015. Available here.
4. European Centre for Disease Prevention and Control. Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV). Available here.
