Seen in World Health Organization
On 17 November 2021, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) in UAE.
The case is a 60-year-old male from the Abu Dhabi region, UAE. He developed fever, sore throat, shortness of breath, and a runny nose on 3 November and presented to hospital on 5 November. On 6 November, he was admitted to hospital where a computerized tomography (CT) scan confirmed the diagnosis of pneumonia. On 11 November, a nasopharyngeal swab was collected and tested positive for MERS-CoV by reverse transcriptase-polymerase chain reaction (RT-PCR). SARS-CoV-2 testing was also performed, and the results were negative. The patient has diabetes, hypertension, and dyslipidemia as co-morbidities. He owns a dromedary camel farm in Abu Dhabi and had a history of close contact with dromedary camels at his farm in the 14 days prior to the onset of symptoms. No travel history was reported during the same period. The patient has recovered and was discharged following two negative tests for MERS-CoV.
Since July 2013, a total of 93 cases including the current case of MERS-CoV have been reported from UAE.
Public health response
Upon identification, an incident report, case investigation and contact tracing were initiated. The investigation is currently ongoing and includes screening of all close contacts at the patient’s household, his camel farm and healthcare facilities. Fifty-one contacts were identified and were monitored daily for the appearance of respiratory or gastrointestinal symptoms for 14 days after their last exposure to the confirmed case.
All samples from close contacts of the patients tested negative for MERS-CoV. One health care worker who identified as a close contact is currently outside of UAE and has been notified and advised to self-monitor. He is asymptomatic.
The veterinary authorities have been notified and an investigation of animals is ongoing.
WHO risk assessment
Middle East respiratory syndrome (MERS) is a viral respiratory infection of humans and dromedary camels which is caused by a coronavirus called Middle East Respiratory Syndrome Coronavirus. Infection with MERS-CoV can cause severe disease resulting in high mortality. Approximately 35% of patients with MERS-CoV have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS-CoV may be missed by existing surveillance systems and until more is known about the disease, the case fatality rates are counted only amongst the laboratory-confirmed cases.
Humans are infected with MERS-CoV from direct or indirect contact with dromedaries who are the natural host and zoonotic source of MERS-CoV infection. MERS-CoV has demonstrated the ability to transmit between humans but it has, so far, mainly occurred in health care settings and to a limited extent among close contacts.
The notification of this additional case does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or animal products (for example, consumption of camel’s raw milk), or in a healthcare setting. WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information. However, with the ongoing COVID-19 pandemic, the testing capacities for MERS-CoV have been severely affected in some countries since most of the resources are redirected to prevent and control the pandemic.
From September 2012 until 18 November 2021, the cumulative number of laboratory-confirmed MERS-CoV infection cases reported globally to WHO is 2,583 with 888 associated deaths. The majority of these cases have occurred in the Arabian Peninsula, with one large outbreak outside this region in the Republic of Korea in May 2015, when 186 laboratory-confirmed cases (185 in Republic of Korea and one in China) and 38 deaths were reported. The global number reflects the cumulative number of laboratory-confirmed cases reported to WHO under the International Health Regulations (IHR 2005) to date. The number of deaths includes the deaths that WHO is aware of to date through follow-up with affected Member States.
Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections and to carefully review any unusual patterns.
Human-to-human transmission in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing infection, prevention and control (IPC) measures. Therefore, IPC measures are critical to prevent the possible spread of MERS-CoV between people in health care facilities. Healthcare workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures or in settings where aerosol generating procedures are conducted. Early identification, case management and isolation of cases, supported quarantine of contacts, together with appropriate infection prevention and control measures and public health awareness can prevent human-to-human transmission of MERS-CoV.
MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions with UAE.