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Epidemiological update: Middle East respiratory syndrome coronavirus (MERS-CoV)

05 Jul 2013
Since the last ECDC update on 18 June 2013, 13 new confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) and two deaths have been reported by the Ministry of Health of Saudi Arabia.
Four of the patients were cases detected among contacts of confirmed cases in Riyadh and the eastern region of Saudi Arabia. Information on these cases is limited, but their ages range from seven to 15 years and all were asymptomatic. Two additional asymptomatic cases were recorded among female healthcare workers in the eastern region and Al-Ahsa. One additional case was reported in a 41-year-old female from Riyadh who had contact with a confirmed case.
In addition, three female health-care workers aged 29, 39 and 45 from the Taif governorate who cared for two previously confirmed MERS-CoV cases were found to have been infected when tested as part of the outbreak investigation and contact tracing. Two of these three cases were asymptomatic.
Finally, three cases were patients from the eastern region: a 43-year-old female who recovered; a 32-year-old male with underlying medical conditions, who later died; and a 50-year-old female who is currently hospitalised with pulmonary disease. Her condition is considered stable. The Ministry of Health of Saudi Arabia also confirmed the death of a previously reported case from the eastern region who was admitted to hospital on 26 April 2013.
Therefore, as of 1 July 2013, 77 confirmed MERS-CoV cases have been reported since the earliest case was identified in April 2012 in Jordan, of which 43 are known to have died. To date, 11 of these cases have been diagnosed in Europe: three in Italy, two in France with one death, two in Germany with one death and four in the United Kingdom with three deaths. Overall, 62 cases have been reported in Saudi Arabia, of which 36 have died. Two cases with two deaths have been reported in Jordan and two cases have been reported in Tunisia.
Meanwhile WHO has revised its case definition. The definition of a confirmed case is unchanged but the definition of a probable case has been expanded with three combinations of clinical, epidemiological and laboratory criteria. It is now less stringent on the exposure (direct epidemiologic link unnecessary for travellers to or residents of Middle Eastern countries) and on clinical criteria (evidence of pneumonia unnecessary for patients with acute febrile respiratory illness and a direct epidemiologic link). ECDC continues to monitor information on the situation of MERS-CoV worldwide. In light of these additional cases, the recommendations given in the rapid risk assessment of 18 June 2013 are still valid.
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