Guidance

UKHSA risk assessment of MERS-CoV

Updated 14 June 2024

Epidemiological update

Over 2,600 cases of Middle East respiratory syndrome (MERS-CoV) have been reported to the World Health Organization (WHO). The majority of MERS-CoV cases have been reported from the Arabian Peninsula, most frequently from the Kingdom of Saudi Arabia, with one large outbreak outside this region in the Republic of Korea (RoK) in 2015. Sporadic cases and small clusters have been detected in countries outside of the Middle East, including the UK, typically imported cases as a result of travel from the Middle East.

MERS-CoV in Saudi Arabia

In KSA, cases of MERS-CoV occur throughout the year. There is currently no evidence of sustained community transmission; limited human-to-human transmission can occur, particularly in healthcare facilities and household clusters. Large outbreaks linked to healthcare facilities are a feature of MERS-CoV and have occurred both within the Middle East and RoK. This underlines the significance of healthcare facilities as a risk factor for amplifying infection, but also the importance of effective and rapid implementation of infection prevention and control practices for possible cases to limit the potential for onward transmission to other patients and staff.

Outside of hospital outbreaks and smaller household clusters, reported cases are sporadic and usually occur in individuals with a history of contact with camels or camel products such as consumption of raw camel milk. UKHSA will continue to monitor the situation internationally.

Risk assessment

The previous sporadic cases to the UK highlight the continued risk of imported cases to the UK, reflecting the epidemiology of MERS-CoV infection in the Middle East. It is therefore imperative that health professionals remain vigilant for clinical presentations compatible with Middle East respiratory syndrome. Symptoms of MERS-CoV typically include fever and cough that can progress to severe pneumonia. MERS CoV is a high consequence infectious disease, therefore early identification is essential through prompt testing and rapid implementation of infection control measures for persons who meet the possible case definition. Local health protection teams should be informed.

The risk of infection with MERS-CoV to UK residents in the UK remains very low.

The risk of infection with MERS-CoV to UK residents travelling to the Middle East is very low, but may be higher in those with exposure to specific risk factors within the region, such as camels (or camel products) or the local healthcare system.

The majority of outbreaks of MERS-CoV in the Middle East have been linked to healthcare settings. A previous WHO mission to Saudi Arabia concluded that gaps in infection control measures have most likely contributed to these outbreaks; this reinforced the importance of strict adherence to recommended infection control measures in healthcare facilities.

Where UK infection control procedures have been followed, the probability of acute respiratory infection in a healthcare worker caring for a case of MERS-CoV, or a case of severe acute respiratory infection of unknown aetiology in the intensive care unit (ICU), being due to MERS-CoV is very low, but warrants testing. Any healthcare worker who develops an acute respiratory illness and has recently been in contact with a confirmed case of MERS-CoV would be tested for the virus. The risk will be higher for healthcare workers exposed to MERS-CoV who have not adhered to UK infection control procedures, such as the use of adequate personal protective equipment (PPE).

The risk to contacts of confirmed cases of MERS-CoV infection is low, but contacts should be followed up for 14 days following last exposure and any new febrile or respiratory illness investigated urgently for MERS-CoV.

Further information and guidance on MERS-CoV is available.

Travel advice

All travellers to the Middle East are advised to avoid contact with camels as much as possible:

• travellers should practice good general hygiene measures, such as regular handwashing with soap and water at all times, but especially before and after visiting farms, barns or market areas
• travellers are advised to avoid raw camel milk and/or camel products from the Middle East
• travellers are also advised to avoid consumption of any type of raw milk, raw milk products and any food that may be contaminated with animal secretions unless peeled and cleaned and/or thoroughly cooked
• travellers should follow the advice of local health authorities; there are currently no travel restrictions in place
• travellers developing fever and cough within 14 days of travel from the Middle East should seek medical advice and must report their travel history so that appropriate clinical assessment, infection control measures and testing can be undertaken
• people who are acutely ill with an infectious disease are advised not to travel but to seek health advice immediately

The Hajj and Umrah

There have been no reported increases in travel-related MERS-CoV cases for previous Hajj pilgrimages. However, cases of MERS-CoV have been imported to countries outside of Saudi Arabia following return from Umrah, a separate pilgrimage which can be performed throughout the year, as illustrated by the most recent Malaysian case.

UKHSA remains vigilant and closely monitors developments in the Middle East and in the rest of the world where new cases have emerged and continues to liaise with international colleagues to assess whether our recommendations need to change.

Infographics for people travelling to the Middle East or returning from the Middle East are available in a range of languages.

The National Travel Health Network and Centre (NaTHNaC) has published travel health advice for Hajj and Umrah.

Further information for health professionals on the possible MERS case definition is available.