Rapid risk assessment: Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV), 22nd update

Risk assessment

European Centre for Disease Prevention and Control. Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV). 22nd update, 29 August 2018. Stockholm: ECDC, 2018. 

This update of ECDC’s risk assessment on MERS-CoV was triggered by the detection of a case imported into the EU/EEA from the Kingdom of Saudi Arabia (KSA). In this update, we reassess the risk for EU/EEA residents.

Executive summary

On 23 August 2018, Public Health England (PHE) reported one case of MERS, detected in England. The patient is a resident of the Kingdom of Saudi Arabia (KSA) who had travelled from Jeddah (KSA) to Manchester (United Kingdom). The case was transferred to an isolation ward after MERS-CoV was suspected and is currently at a specialised hospital in Liverpool in a stable, ambulatory condition. According to the UK authorities, a limited number of close contacts have been identified and are being followed up. This is the fifth case of MERS-CoV reported from the UK.

The majority of the MERS-CoV infections continue to be reported from the Middle East and more specifically from the Kingdom of Saudi Arabia. Sporadic MERS-CoV infections in travellers returning to EU/EEA countries can be expected, given the regular occurrence of MERS-CoV infections in the Middle East and the substantial number of people travelling between the region and EU countries.

European public health authorities should remain vigilant, continue surveillance of acute respiratory infections and maintain preparedness for travel-related MERS cases entering the EU/EEA. Information about the risk of MERS should be shared with clinicians to maintain increased awareness for early identification, isolation and diagnosis of possible MERS. Adherence to strict infection control protocols throughout contact with possible cases is critical for preventing further spread of MERS-CoV in healthcare settings.  Previously issued advice for travellers, including pilgrims, and healthcare workers remains valid. EU residents travelling to Middle Eastern countries need to be made aware that MERS-CoV is circulating in these areas. Close contact with dromedary camels, consumption of raw/undercooked camel products, such as milk, and transmission in hospital settings are the main sources of infection.  

Countries should advise travellers returning from all areas affected by MERS-CoV to seek medical attention if they develop a respiratory illness with fever and cough or diarrhoea during the two weeks following their return, and to disclose their recent travel history to their healthcare provider.

The risk of widespread transmission of MERS-CoV in the community after sporadic importation into the EU/EEA remains very low. The risk of transmission of MERS-CoV in the healthcare setting after sporadic importation into the EU/EEA remains low, provided appropriate infection control measures are implemented rapidly when seeing suspected cases.