21 June 2013
Middle East respiratory syndrome coronavirus, MERS-CoV: Saudi Arabia - update on case numbers
This updates the previous Clinical Update of 10 June 2013
As of 17 June 2013, the total number of cases of MERS-CoV reported globally by the World Health Organization (WHO) is 64, including 38 deaths .
Details of these cases can be found in the summary table below :
|United Kingdom (UK||
|United Arab Emirates (UAE)||
From 14 June to 17 June 2013, the Ministry of Health in Saudi Arabia informed the WHO of nine additional cases of MERS-CoV. The new cases were reported from Al-Ahsa region, Eastern region, Hafar Al-Batin governorate, Riyadh region, Jeddah, Taif governorate, and Wadi Al Dawaser [1,3,4].
Four countries in the Middle East, Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) have reported cases France, Germany, Italy, Tunisia and the United Kingdom, have all now reported MERS-CoV cases. All these latter cases have had either direct or indirect connections to the Middle East .
Although sustained person-to-person transmission has not been observed, limited person-to-person transmission has been reported either in a household, work environment, or health care setting [5-7].
The source of infection remains unknown, and although some cases have reported an animal exposure, a specific animal reservoir has not been identified. Investigations are on-going [5-7].
The number of visitors to Saudi Arabia is expected to increase significantly in the coming months, when Ramadan begins . All pilgrims to Mecca (Hajj and Umrah) are advised to check NaTHNaC’s health information sheet for the latest recommendations.
There are no travel restrictions to the Middle East. The risk of UK residents contracting infection in the UK is very low. The risk to people travelling to Middle Eastern countries may be slightly higher than within the UK, but is still very low.
Travellers returning from the Middle East and surrounding countries, with mild respiratory symptoms are most likely to have a common respiratory illness such as a cold. However, if severe respiratory symptoms develop, such as shortness of breath, within two weeks of returning from these countries, medical advice should be sought from their GP or NHS 111. Returning travellers should mention which countries they have visited.
PHE have already prepared a series of documents for both the general public and healthcare professionals including risk assessments and advice on how cases should be managed. Clinical queries about the management of potential cases of severe respiratory infections in people who have recently visited Saudi Arabia, Qatar, Jordan, or UAE, or the neighbouring countries of Bahrain, Iraq, Israel, Kuwait, Lebanon, Oman, Syria, and Yemen, should be directed in the first instance to the local infectious disease physician or microbiologists. The national Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed (0844 7788990).
Currently there is no change to travel advice, please refer to our previous NaTHNaC Clinical Update for more information.
1. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) - update.17 June 2013. [Accessed 21 June 2013]. Available at: http://www.who.int/csr/don/2013_06_17/en/index.html
2. U.S Centers for Disease Control and Prevention. Middle East Respiratory Syndrome (MERS). 19 June 2013. [Accessed 21 June 2013]. Available at: http://www.cdc.gov/coronavirus/MERS/
3. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) - update 15 June 2013. [Accessed 21 June 2013]. Available at: http://www.who.int/csr/don/2013_06_15/en/index.html
4. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) - update 14 June 2013. [Accessed 21 June 2013]. Available at:
5. European Centre for Disease Prevention and Control. Middle East respiratory syndrome coronavirus: updated guidance in ECDC Rapid Risk Assessment. 18 June 2013. [Accessed 21 June 2013]. Available at: http://ecdc.europa.eu/en/publications/Publications/MERS-CoV-novel-coronavirus-risk-assessment.pdf
6. Health Protection Agency. Update on family cluster of novel coronavirus infection in the UK. 19 February 2013. [Accessed 21 June 2013]. Available at: http://www.hpa.org.uk/NewsCentre/NationalPressReleases
7. World Health Organization. Middle East respiratory syndrome - coronavirus (MERS-CoV) – Update. 5 June 2013. [Accessed 21 June 2013]. Available at: