Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV), 5 June 2015
This risk assessment was triggered by a large cluster of confirmed MERS-CoV cases in South Korea, generated by a primary case imported from the Middle East. This is the largest cluster observed outside of the Arabian Peninsula so far.
Executive Summary
The evolving cluster of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea is the largest of its kind outside of the Middle East. Travel associated MERS-CoV infections, such as the primary case in the South Korean cluster, are not unexpected nor are instances of secondary infections. It is the scale of this cluster and that an infected person travelled to China that makes this particularly noteworthy. However, ECDC’s assessment continues to be that the MERS-CoV outbreak poses a low risk to the EU and highlights the importance of rapid consideration of MERS-CoV and infection control measures in healthcare settings.
Risk to travellers to South Korea
The South Korean cluster has affected patients, visitors of patients and healthcare workers in a few healthcare facilities and close relatives of the cases. The outbreak so far does not represent an increased risk of infection for travellers or visitors to South Korea. However, patients who present with severe acute respiratory disease in the EU and have recently been in contact with healthcare services in South Korea should be considered for assessment for MERS-CoV, similar to patients having been in contact with healthcare services in the Middle East.
WHO has stated that there is currently no indication that the virus is behaving differently to how it has behaved in the past and that there is no indication of sustained transmission from person to person. However, further details of the virus characterisation in South Korea are pending.
Surveillance and infection control essential
International surveillance for MERS-CoV cases among travellers remains essential due to the continued risk of an infected person travelling to Europe after exposure in the Middle East. Moreover rapid efforts to contain nosocomial clusters are vital to prevent broader transmission. Although sustained human-to-human transmission is unlikely, secondary transmission to unprotected close contacts remains a risk, especially in healthcare settings, as now documented in South Korea.
Systematic implementation of infection control measures in hospital settings is essential to interrupt transmission and prevent clusters of healthcare-associated infection. The challenges of detecting rare imported cases of respiratory infection early on highlight the need for eliciting travel history from patients and adequate infection prevention and control measures for all patients showing symptoms of acute respiratory infection.
Since the previous update of the Rapid Risk Assessment dated 8 March 2015, there have been 129 new cases and 53 additional deaths from MERS-CoV reported globally: Saudi Arabia (81 cases and 48 deaths), Qatar (3 cases and one death), Oman (one case) United Arab Emirates (two cases), Iran (one case) South Korea (40 cases and four deaths) and China (one case).