Epidemiological update: additional confirmed cases of Middle East respiratory syndrome coronavirus (novel coronavirus) in France, Saudi Arabia and Tunisia

Epidemiological update

Since last ECDC update on 17 May 2013, one probable and six new confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported.

One case was reported by the Ministry of Social Affairs and Health in France [2]. The patient shared the same hospital room in France with a previously reported MERS-CoV case with a recent history of travel to Dubai. Infection resulted most probably from human-to-human transmission.

Three cases were reported by the Ministry of Health of the Kingdom of Saudi Arabia [3-4].  Two of these cases, a 43-year-old woman with co-existing health conditions and a 45-year-old man, were healthcare workers associated with a cluster in Al-Hasa, Eastern Province of Saudi Arabia, and linked to the same healthcare facility [3]. The third case was a 63-year-old non-Saudi patient with an underlying medical condition who was admitted to hospital on 15 May and died on 20 May in the Al-Qaseem region, central Saudi Arabia [4-5].

Finally, three cases were reported by the Ministry of Health of Tunisia [6]. The index patient is a 66-year-old man with underlying health conditions and a recent travel history to Qatar and Saudi Arabia who died on 10 May 2013. Infection with MERS-CoV was not laboratory confirmed and the case is currently defined as probable. The two confirmed cases, a 34-year-old man and a 35-year-old woman, are the children of the index patient and travelled with the father during his journey. Both children had mild respiratory illness and did not require hospitalisation.

As of 23 May 2013, 44 confirmed MERS-CoV cases have been reported since the earliest case identified in April 2012 in Jordan, of which 22 are known to have died. To date, eight of these cases have been diagnosed in Europe: two in France [3], two in Germany [7] and four in the United Kingdom [8]. Overall, 31 cases have been reported in Saudi Arabia, 22 of these were associated with the cluster in Al-Hasa [6].

Due to the large number of guest workers in Saudi Arabia, WHO expressed concerns about possible importation of MERS-CoV into the Indian subcontinent and the Philippines, where investigating and controlling the virus transmission could be more challenging [9].

ECDC continues to monitor information on the situation of MERS-CoV worldwide. In the light of these new developments, the recommendations given in the rapid risk assessment of the 17 May 2013 are still valid [1].