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Ongoing outbreak of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

28 Jun 2013
​An article published on 21 June in the New England Journal of Medicine describes a healthcare associated outbreak of Middle East respiratory syndrome (MERS-CoV) infection in the Al-Ahsa region of the Kingdom of Saudi Arabia. During the outbreak, which involved 4 healthcare facilities, a total of 23 confirmed and 11 probable cases were reported. The majority of the cases reported were patients at the healthcare facilities, but five family members and two healthcare workers were also affected.  The most heavily affected department was a hemodialysis unit at one of the hopsitals, where infection was confirmed in nine patients. Transmission apparently occurred also in the ICU and the medical ward. One of the patients in the hemodialysis unit transmitted the infection to seven persons, one patient transmitted the infection to three persons, and four patients transmitted the infection to two persons each. Implementation of contact and droplet precautions was reportedly followed by termination of the outbreak.
The epidemiologic and phylogenetic analysis indicates that there was human-to-human transmission. Until now it has not been possible to determine whether transmission occurs through contact and respiratory droplets alone. Moreover, transmission also apparently occurred between rooms of the same ward and there were similarities with the transmission pattern of SARS-CoV, which has also been associated with airborne transmission. Consequently, airborne transmission of MERS-CoV cannot be excluded with the currently available data. (1)
ECDC Comments: 27 June 2013
Based on this information, the risk of healthcare-associated transmission of MERS-CoV appears to be significant. Healthcare workers caring for patients under investigation for and confirmed cases of MERS-CoV infections in the EU/EEA should, in addition to standard precautions, practise both contact and airborne transmission precautions, as outlined in the ECDC rapid risk assessment.
ECDC is closely following any epidemiologic developments and the risk assessment will be updated when significant new information arises.
(1) Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus, 19 June 2013,
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