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Epidemiological update: MERS-CoV case imported to Turkey

22 Oct 2014

​On 18 October 2014, the Ministry of Health Turkey reported that a Turkish citizen working in Saudi Arabia died on 11 October 2014, ten days after onset of a confirmed MERS-CoV infection. The case returned to Turkey on 10 October 2014. It is assumed that the case was symptomatic during the flight. The local health authorities are conducting contact tracing.

Worldwide situation

Overall, 906 laboratory-confirmed cases of MERS-CoV have been reported to the public health authorities worldwide, including 361 deaths as of 21 October 2014 (Figure 1).

Figure 1. Distribution of confirmed cases of MERS-CoV reported as of 21 October 2014, by date and place of probable infection (n=906)



 
Most of the cases have occurred in the Middle East (Saudi Arabia, United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Egypt, Yemen, Lebanon and Iran) (Table 1).
 
Between 1 September and 21 October 2014, the health authorities in Saudi Arabia reported 29 cases, 15 of which were in Taif. Twenty-four of them (83%) are male, of which 20 (83%) above 40 years of age. Comorbidities were reported in 20 of the 29 cases. Four cases were reported among healthcare workers. Several cases had contact with animals, including camels, and some reported having drunk camel milk.
 
On 20 October, the Ministry of Health of Saudi Arabia issued a press release about the implementation of measures to control the cluster of cases in Taif, in particular addressing the dialysis units. 

Table 1. Number of confirmed cases and deaths, by country of reporting as of 21 October 2014

Reporting country

Cases

Deaths

Date of onset/reporting for most recent cases

Middle East

 

 

 

Saudi Arabia

771

328

21/10/2014

United Arab Emirates

73

9

11/06/2014

Qatar

8

4

12/10/2014

Jordan

18

5

23/05/2014

Oman

2

2

20/12/2013

Kuwait

3

1

07/11/2013

Egypt

1

0

22/04/2014

Yemen

1

1

17/03/2014

Lebanon

1

0

22/04/2012

Iran

5

2

25/06/2014

Europe

 

 

 

Turkey

1

1

06/10/2014

Austria

1

0

29/09/2014

United Kingdom

4

3

06/02/2013

Germany

2

1

08/03/2013

France

2

1

08/05/2013

Italy

1

0

31/05/2013

Greece

1

1

08/04/2014

Netherlands

2

0

05/05/2014

Rest of the world

 

 

 

Tunisia

3

1

01/05/2013

Algeria

2

1

24/05/2014

Malaysia

1

1

08/04/2014

Philippines

1

0

11/04/2014

United States of America

2

0

01/05/2014

Total

906

361

Geographical distribution

All cases reported outside of the Middle East have had a recent travel history to the Middle East or contact with a case who had travelled from the Middle East (Figure 2).
 

Figure 2. Geographical distribution of confirmed MERS-CoV cases and place of probable infection, worldwide, as of 21 October 2014 (n=906)


 

Conclusions

• The incidence of cases in September and October 2014 is slightly higher than in July and August 2014. This pattern was also observed in 2012 and 2013. The majority of MERS-CoV cases are still being reported from the Arabian Peninsula, specifically from Saudi Arabia, and all cases have epidemiological links to the outbreak epicentre.
• According to the pattern observed in 2012 and 2013, more cases could be observed in the coming weeks.
• The latest importation to the EU (Austria) and to Turkey are not unexpected and do not indicate a significant change in the epidemiology of the disease. Importation of MERS-CoV cases to the EU remains possible. However, the risk of sustained human-to-human transmission remains very low in Europe.
 

Further Reading

• WHO Emergency Committee issued a Statement on the Seventh Meeting of the IHR Emergency Committee regarding MERS-CoV (1 October 2014) .The emergency committee concluded that the conditions for a Public Health Emergency of International Concern have not been met and recommended a number of public health measures concerning mainly the affected countries and countries in Africa.
• Global Alert and Response (GAR) Corona virus infections. WHO has issued new surveillance guidance, case definitions and laboratory guidance, which were referred to in the ECDC Rapid Risk Assessment published on 21 August 2014.
• Public Health England published a Risk Assessment of Middle East Respiratory Syndrome Coronavirus (MERS CoV) 9 October 2014.
• Ministry of Health of Austria reported of a MERS-CoV case with recent travel history to Saudi Arabia.
ECDC rapid risk assessment: Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV) – Update, 16 October 2014.
• WHO. Middle East respiratory syndrome coronavirus (MERS-CoV) - Austria, Disease Outbreak News, 2 October 2014.
• Saudi Arabian Ministry of Health: Press releases.
• WHO Laboratory Testing for Middle East respiratory syndrome Coronavirus, interim recommendations (revised) September 2014.
WHO travel advice on MERS-CoV for pilgrimages to Umra and Hajj.
• Ministry of Health of Saudi Arabia: Guidelines for pilgrims.
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