​With MERS-CoV cases in steady decline, risk to EU remains low

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​As the number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases has been steadily declining over the past months since the upsurge of cases in the Arabian Peninsula in April and May 2014, ECDC concludes in its updated risk assessment that the current risk of human infections and sustainable human-to-human transmission of MERS CoV in Europe remains low.

Risk to Europe remains low

As the number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases has been steadily declining over the past months since the upsurge of cases in the Arabian Peninsula in April and May 2014, ECDC concludes in its updated risk assessment that the current risk of human infections and sustainable human-to-human transmission of MERS CoV in Europe remains low. After detection of imported cases in Europe, further transmission of MERS CoV has been very limited, and appropriate infection control and contact tracing methods appear to successfully limit further transmission.
 

All cases associated with the Middle East

Since September 2012 when the virus was first identified and as of 20 August 2014, 855 cases of MERS CoV have been reported to public health authorities worldwide, including 333 deaths. Most of the cases (97,5%) have occurred in the Middle East. All other cases have had a recent travel history to the Middle East, or have been in contact with a case who has travelled to the Middle
East.
 

Inconclusive evidence points to epidemic seasonality associated with dromedary camels

There is growing evidence that dromedary camels play an important role in the transmission to humans and are the direct or indirect source of infection in many of the human cases. The current pattern of disease appears to be the combination of repeated introductions of the virus from camels to people, resulting in limited, un-sustained, human-to-human transmission. The epidemic peak observed in the spring might be explained by the annual cyclicality of camel breeding in Saudi Arabia. However there is limited evidence to prove or discard this hypothesis.
 

Infection in healthcare settings

The majority of cases reported so far are associated with healthcare settings, and WHO missions have concluded that suboptimal implementation of infection control procedures have contributed to these outbreaks. At the same time, more detailed information and studies are needed to identify risk and protective factors for infection in hospitals.
 

Hajj, the annual Muslim pilgrimage to Saudi Arabia in October

Hajj, the annual Muslim pilgrimage is expected to take place around the first week of October in 2014, and cases among pilgrims or in the healthcare facilities providing services to the pilgrims can be expected, considering the large increase of cases detected and reported in 2014 so far.
 

Gaps in knowledge to be filled

MERS CoV outbreak has had a serious public health impact in the Arabian Peninsula and has the potential to spread and have a wider geographical impact. The assessment of risk for the EU is limited by gaps in knowledge of the animal-human interface, as the direct source of the infection remains unidentified. Serological and case-control studies are needed to understand risk factors and ways to protect from the disease.
 
 Rapid risk assessment: Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV). Eleventh update, 21 August 2014
 
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