16 December 2013
Middle East respiratory syndrome coronavirus (MERS-CoV): updated case numbers and revised guidance for travellers.
This reviews the previous Clinical Update of 11 November 2013
Worldwide, from September 2012 to date, WHO has been informed of a total of 163 laboratory-confirmed cases of infection with MERS-CoV, including 71 deaths . Cases have been confirmed from Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the UAE . Twelve cases have been imported to France, Germany, Italy, Tunisia and the United Kingdom (UK); each of these had a history of travel to the Middle East [2, 3]. Local secondary transmission following importation has been reported in France, Tunisia and the UK . Probable cases have also been reported from Spain [2, 4].
A recent WHO report indicates that animals could be a possible source of infection, or the intermediate hosts, however the virus reservoir remains unknown. On 10 November 2013, the Ministry of Health of Saudi Arabia announced the detection of MERS-CoV in a specimen taken from an ill camel owned by a laboratory-confirmed case from Jeddah .
On 27 November 2013, the Qatar authorities notified WHO of the detection of MERS-CoV in a herd of camels in a barn linked to two confirmed human infections . The significance of these findings is currently unclear. It may provide additional evidence of a possible role of zoonotic transmission .
Advice for travellers
The risk of UK residents contracting infection in the UK remains very low. The risk to UK residents travelling to Middle Eastern countries may be slightly higher than within the UK, but is still very low.
Travellers at high risk of severe disease due to MERS-CoV (such as immunosuppressed individuals and those with underlying respiratory or cardiac conditions) should avoid farms or barns areas where the virus is known to be potentially circulating .
If visiting a farm or a barn, all travellers should adhere to general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals and ensuring good personal and food hygiene practices .
Travellers returning from the Middle East and surrounding countries within 14 days, with mild respiratory symptoms, are most likely to have a common respiratory illness such as a cold. However, if more severe respiratory symptoms develop, such as increasing 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.
Advice for Health Professionals
The level of risk in those who come to the UK from, or return from, the Middle East and meet the case definition for a “case under investigation” is very low, but warrants testing for MERS-CoV infection .
Public Health England provides guidance for both the general public and healthcare professionals. Information for health professionals includes guidance on risk assessment and case management.
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, Occupied Palestinian territories, 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 required (0844 7788990).
Please refer to previous NaTHNaC Clinical Updates for more information.
1. World Health Organization. Middle East respiratory syndrome coronavirus (MERS - CoV) – update. 2 December 2013. [Accessed: 16 December 2013]. Available at: http://www.who.int/csr/don/2013_12_02/en/index.html
2. European Centre for Disease Prevention and Control. Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV). 25 November 2013. [Accessed 16 December 2013]. Available at:
3. European Centre for Disease Prevention and Control. Monitoring current threats: EDCE Communicable Disease Threats Report: Middle East respiratory syndrome coronavirus (MERS-CoV). 10 December 2013. [Accessed 16 December 2013]. Available at: http://tinyurl.com/o6wv8no
4. Spain’s Ministry of Health, Social Services and Equality. Caso Importado del Nuevo Coronavirus en Espana. Cierre de la Alerta. 21 November 2013 [in Spanish]. [Accessed 16 December 2013]. Available at: http://www.msssi.gob.es/profesionales/saludPublica
5. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update. 22 November 2013. [Accessed 16 December 2013]. Available at: http://www.who.int/csr/disease/coronavirus_infections/Update1
6. World Health Organization Middle East respiratory syndrome coronavirus (MERS-CoV) – update. 29 November 2013. [Accessed 16 December 2013]. Available at: http://www.who.int/csr/don/2013_11_29/en/index.html
7. Public Health England. PHE Risk Assessment – Middle East Respiratory Syndrome (MERS – CoV). 11 December 2013. [Accessed 16 December 2013]. Available at: