Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV), 1 September 2015
Since April 2012 and as of 2 September 2015, 1 545 cases of MERS (including 588 deaths) have been reported by health authorities worldwide.
Since April 2012 and as of 2 September 2015, 1 545 cases of MERS (including 588 deaths) have been reported by health authorities worldwide (Figure 1 and Table 1).
Figure 1. Distribution of confirmed cases of MERS by month* and probable place of acquisition of infection, March 2012 – 2 September 2015 (n=1 545)
Since the previous update of the ECDC Rapid Risk Assessment on MERS-CoV (27 August 2015), 34 new cases and 14 deaths have been reported from Saudi Arabia (30 cases and 12 deaths) and Jordan (four cases and two deaths).
Between March 2012 and 2 September 2015, the majority of the cases have occurred in the Middle East, most of them (95%) in Saudi Arabia and the United Arab Emirates (Table 1). However, South Korea has reported the highest number of cases outside the Middle East.
Table 1. Confirmed MERS cases and deaths, by country of reporting, March 2012 – 2 September 2015
|Middle East||1 332||541|
|Saudi Arabia||1 195||510|
|United Arab Emirates||81||11|
|Rest of the world||7||2|
|United States of America||2||0|
All cases reported from outside the Middle East have either had a recent travel history to the Middle East or could be linked to a chain of transmission originating from a case with a travel history to the Middle East (Figure 2).
Figure 2. Distribution of confirmed MERS cases by probable place of acquisition of infection, as of 2 September 2015 (n=1 545)
According to WHO the four cases reported from Jordan between 26 and 28 August 2015 seem to be part of a MERS-CoV outbreak at a hospital in Amman.
The first case reported was a 60-year-old man who lived in Jeddah, Saudi Arabia, but had travelled to Amman on 28 July 2015. The onset of symptoms began on 31 July and he was hospitalised for the first time from 10 to 18 August. However, he was readmitted to another hospital on 20 August. It is not known how this case became infected.
The second case is a 38-year-old man from Kuwait City who travelled to Amman on 7 August 2015. He developed symptoms on 12 August. He was hospitalised on 17 August in the same hospital where the first case was treated. One possible exposure is that he frequently visited a family member who was being treated at the same hospital as the first case.
The third case is a 76-year-old man from Amman who was hospitalised for treatment of a chronic health condition on three different occasions at the same hospital as the two previous cases. According to WHO he was hospitalised twice for an underlying condition and then admitted on 20 August 2015 after he was diagnosed with MERS-CoV.
The fourth case is a 47-year-old woman from Kuwait City who travelled to Amman on 15 July 2015. She is a contact of the second case and tested positive for MERS-CoV on screening tests. She is asymptomatic and is in home isolation. Her only known exposure is that she visited family members at the hospital where the first patient was being treated.
In addition to the four cases mentioned, Jordan has announced two extra cases, a 56-year-old Jordanian man who was diagnosed with MERS-CoV after undergoing surgery and a 74-year-old woman who has pre-existing medical conditions.
Since the beginning of 2015, Saudi Arabia has reported 367 cases, of which 30 were reported after ECDC’s risk assessment of 27 August 2015. Twenty-eight of the cases occurred in Riyadh (Figure 4) and two in Najran.
Figure 3. Number of cases (n=131) reported by Saudi Arabia in Riyadh, 3 August 2015 – 2 September 2015, by date of reporting
For four of the 30 cases it was clearly indicated that they did not have any contact with a previously identified or suspected case. The remaining 26 cases had either had contact, or were under review for having had contact, with suspected or confirmed cases in the community or hospital. This may indicate that there might be a low-level community transmission but the majority of the cases are clearly related to nosocomial transmission of MERS-CoV in Saudi Arabia. Six of the 30 cases are healthcare workers.