Middle East respiratory syndrome coronavirus (MERS-CoV), 11 June 2015

Risk assessment
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European Centre for Disease Prevention and Control. Severe respiratory disease associated with MERS-CoV, 11 June 2015. Stockholm: ECDC, 2015.

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​This update was prompted by the recent increase in the number of confirmed MERS-CoV cases in South Korea. The South Korean disease cluster was generated by a primary case imported from the Middle East and is the largest cluster observed outside of the Arabian Peninsula so far.

Executive summary

he cluster of Middle East respiratory syndrome coronavirus (MERS-CoV) continues to evolve in South Korea, where 107 confirmed cases and nine deaths have been reported as of 10 June 2015 and since the first case was diagnosed on 20 May 2015. While it is the largest cluster of MERS-CoV seen outside of the Arabian Peninsula, it follows the pattern of transmission in Saudi Arabian hospitals when extended nosocomial transmission was observed, and is thus not unexpected.

ECDC’s latest assessment continues to conclude that the current MERS-CoV outbreak poses a low risk to the EU. It highlights the importance of rapid consideration of MERS-CoV and strict adherence to infection control measures in healthcare settings, as well as suggests raising travellers’ awareness of the presence of MERS-CoV in the Middle East and in South Korea.

Risk to travellers to South Korea

The outbreak so far does not represent an increased risk of infection for travellers or visitors to South Korea. However, EU citizens travelling to the Middle East and South Korea need to be aware of the presence of MERS-CoV in these areas, especially in healthcare facilities, as continued exposure in affected healthcare facilities cannot be excluded. Travellers who have visited healthcare facilities in the Middle East and South Korea who develop respiratory symptoms up to 14 days after return should seek medical attention, indicating their travel history.

Surveillance and infection control of paramount importance

ECDC risk assessment once again reasserts the importance of international surveillance for MERS-CoV cases among travelers. Rapid efforts to contain nosocomial clusters in the Middle East and South Korea are vital to prevent broader transmission.

Rigorous implementation of infection prevention and control measures in hospitals is essential to interrupt transmission and prevent clusters of infection. Detecting rare imported cases early on is a challenge that highlights the need for adequate infection prevention and control measures for all patients showing symptoms of acute respiratory infection.

Continued investigation needed

Additional information on clinical presentation, further details on epidemiological features of the cluster, and knowledge of MERS-CoV genetic sequences are required to confirm our current conclusions. In addition, more details on the potential exposure in the community of the index case would help to elucidate the potential source of the infection and the cause of the high number of secondary cases.