​Rapid Risk Assessment: Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV). 20th update, 27 August 2015

Risk assessment
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European Centre for Disease Prevention and Control. Middle East respiratory syndrome coronavirus (MERS-CoV). 20th update, 27 August 2015. Stockholm: ECDC, 2015.

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This update was prompted in response to a large nosocomial outbreak of MERS in Riyadh, in order to assess whether this event changes the risk of international spread or increases the risk to EU citizens living in or travelling to Saudi Arabia. Furthermore, the update includes assessment of the risk of infection and introduction into the EU associated with pilgrims visiting Saudi Arabia during the upcoming Hajj.

Executive summary

​A large nosocomial outbreak of MERS in Riyadh, Saudi Arabia has triggered an update of ECDC’s rapid risk assessment, in order to assess whether this event changes the risk of international spread or increases the risk to EU citizens living in or travelling to Saudi Arabia. The update also includes an assessment of the risk of infection and introduction into the EU associated with pilgrims visiting Saudi Arabia during the forthcoming Hajj.  Given the substantial number of people travelling between the Middle East, which continues to report the majority of MERS cases, and EU countries, imported, sporadic cases to Europe can be expected.  Over 110 new cases and 30 deaths have been reported globally so far for August 2015 alone, almost all of them from Saudi Arabia. When compared to previous years, the increase in reported MERS cases in August is unexpected and is mainly explained by a large, ongoing outbreak linked to one Riyadh hospital.

The extent to which other healthcare facilities in Riyadh are affected is unknown, as is the number of asymptomatic individuals who may be infected with MERS-CoV.

The role of hospitals as amplifiers of MERS-CoV infection is well known, so the strict and timely application of comprehensive infection prevention and control measures is imperative. Sporadic, imported cases can be expected in EU/EEA Member States, and is associated with a risk of nosocomial spread. This highlights the need for awareness among healthcare workers, early detection through functioning testing algorithms, preparedness planning and stringent infection control precautions.