Rapid risk assessment: Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV), 18th update, 30 June 2015

Instances of Middle East respiratory syndrome coronavirus (MERS-CoV) infection continue to be reported in the Middle East and South Korea but the outbreak continues to pose a low risk to the EU with regards to the importation of MERS cases. Although sustained community transmission has not been observed, transmission to close contacts of imported cases, including to healthcare workers, other patients and visitors in hospitals has been reported, most recently in South Korea but also in France, the United Kingdom and Iran.

 ECDC’s rapid risk assessment has been updated in light of the forthcoming Summer Universiade, an international sports event with an estimated 20 000 participants (athletes and officials) from 170 countries, in Gwangju, South Korea from 3 to 14 July 2015.

 

Since the previous update of the ECDC Rapid Risk Assessment on MERS-CoV (11 June 2015), 92 new cases and 33 deaths have been reported globally from: South Korea (74 cases and 23 deaths), Saudi Arabia (12 cases and 8 deaths), United Arab Emirates (4 cases and 1 death), Germany (one death in a travel-related case reported in March 2015) and Thailand who reported a travel-related MERS case from Oman to Bangkok on 18 June 2015.

 

The majority of cases have occurred in the Middle East, most of them in Saudi Arabia and the United Arab Emirates. However, South Korea is the country with the highest number of new cases reported since the start of the outbreak there in early May 2015.

Risk to travellers to South Korea

The risk for visitors to South Korea is extremely low, unless visitors have had contact with healthcare facilities, in particular in the 13 affected districts. The risk for participants in Universiade events, is similarly extremely low as no MERS cases have been reported from the districts where Universiade events will take place.

Risk to travellers to Saudi Arabia

The risk for visitors to Saudi Arabia is low, and related to exposures either to live camels and camel products or to healthcare facilities. The risk is considered higher than in South Korea because of the high number of nosocomial clusters identified in Saudi Arabia, the persistence of transmission in healthcare settings for more than two years, the suspicion of infections occurring through unrecognised chains of transmissions and the risk related to exposure to camels and camel products.

No travel restrictions advised

WHO does not recommend travel restrictions with regards to MERS-CoV, but rather to raise awareness among travellers to and from affected countries. EU citizens travelling to the affected countries in the Middle East and to South Korea should be aware that MERS-CoV is circulating in these areas and are reminded of general travel advice of good hand and food hygiene.

 

Participants in the Universiade in South Korea in July 2015 should follow the recommendation published by the organiser of the event, International University Sports Federation (FISU), which states that “all persons involved in the FISU Summer Universiade should take strict precautions for good health procedures (i.e. wash hands, do not cough on others, make sure bodily fluids are self-contained). No-one is to travel to these Games or from your country if they have symptoms of any illness or have fever, cough or signs/symptoms of respiratory infection.”

 

In light of the ongoing outbreak, travellers returning from the Middle East and South Korea should be made aware that if they develop respiratory symptoms or diarrhoea, either during travel or up to 14 days after their return, they should seek medical attention and report their travel history. Patients presenting with severe acute respiratory disease in the EU and have recently been in South Korea or the Middle East and had contact with MERS patients, healthcare services or camels, should be investigated for MERS-CoV infection.