19 May 2016

MERs-CoV update: Saudi Arabia and South Korea

Update to risk assessment for the Middle East (including Saudi Arabia) and South Korea MERs-CoV update: Saudi Arabia and South Korea

As of 16 May 2016, a total of 1,733 cases of MERS-CoV infection, including 628 deaths, have been reported to the World Health Organization (WHO) since September 2012 [1]. The majority of cases have been reported from the Kingdom of Saudi Arabia (88%) and other countries in the Arabian Peninsula [2].

Dromedary camels have been identified as an important host species for MERS-CoV. The epidemic has been characterised by sporadic infections following close contact with camels, as well as secondary cases and the occasional larger outbreak with human-to-human transmission in hospital settings. Sporadic hospital outbreaks have been reported from the Middle East, and a particularly large hospital outbreak, involving 186 cases, occurred in the Republic of Korea in 2015 [2].

Risk assessment

  • The risk of infection with MERS-CoV to UK residents in the UK remains very low [2].
  • The risk of infection with MERS-CoV to UK residents travelling to the Middle East is very low. The risk may be higher in those with exposure to specific risk factors within the region such as camels (or camel products) or the local health care system [2].

Advice for travellers

If you are travelling to the Middle East (including KSA), Public Health England advises that you should:

  • Avoid all contact with camels and sick animals.
  • Practise good general health measures, such as regular hand washing with soap and water, at all times but especially after visiting farms, barns or market areas.
  • Avoid raw camel milk and/or camel products from the Middle East.
  • Avoid consumption of any type of raw milk, raw milk products and any food that may be contaminated with animal secretions unless peeled and cleaned and/or thoroughly cooked [2].

If you are planning to visit KSA to undertake Hajj or Umrah, please read the factsheet where further information is available.

If you have returned from the Middle East or South Korea (RoK), and are experiencing mild respiratory (breathing) symptoms, it is most likely you have a common respiratory illness, such as a cold. However, if you have more severe respiratory symptoms you should seek medical advice from your GP or NHS111. It is important to give details of your recent travel history to the health professional, so that appropriate measures and testing can be undertaken [2].

Advice for health professionals

There remains a risk of imported cases to the UK from the Middle East, and health professionals should remain vigilant. MERS-CoV transmission can occur in health care settings if suspected cases are not promptly identified and isolated. Early identification and implementation of strict infection control measures for suspected cases is crucial [2].

Health care providers in the UK are reminded to remain alert for recent travellers returning from areas affected by the virus who develop a severe unexplained respiratory illness and who meet the case definition (see PHE case management algorithm) for possible case of MERS-CoV. Although the likelihood of MERS-CoV is low in such travellers, testing should be undertaken to exclude the infection [2].

In addition, unexplained clusters of severe respiratory infection, whether or not they have travelled, should be investigated, particularly if they occur in health care settings.  The likelihood of MERS-CoV is very low, but warrants investigation and testing; a history of recent travel to the Middle East or South Korea would increase the likelihood of MERS-CoV [2].

Public Health England provides guidance for health professionals on the management of MERS-CoV.

Clinical queries about the management of potential cases of severe respiratory infections in people recently returned from regions reporting outbreaks should be directed in the first instance to the local infections disease physician or microbiologist. The Public Health England imported fever service is available to local infectious disease physicians or microbiologists should specialist advice be required.

For specific country advice, check our Country Information pages.

Resources

  1. World Health Organization (2016) Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – Saudi Arabia http://www.who.int/csr/don/16-may-2016-mers-saudi-arabia/en/ [Accessed 19 May 2016]
  2. Public Health England (2016) Risk assessment of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Updated: 7 March 2016. https://www.gov.uk/government/publications/mers-cov-risk-assessment [Accessed 19 May 2016]

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