#MERS #Coronavirus - Global #update (#WHO D.O.N., Dec. 24 '25)

 

Situation at a glance

Since the beginning of 2025 and as of 21 December 2025, a total of 19 cases of Middle East respiratory syndrome coronavirus (MERS- CoV), including four deaths have been reported to WHO globally. 

Of the 19 cases, 17 were reported by the Kingdom of Saudi Arabia (KSA), and two were reported from France. 

Between 4 June and 21 December 2025, the Ministry of Health (MoH) of KSA reported a total of seven cases of MERS-CoV infection, including two deaths. 

In addition, at the beginning of December 2025, the National IHR Focal Point (IHR NFP) for France also reported two MERS-CoV travel – associated cases; involving individuals with recent travel to countries in the Arabian Peninsula. 

The notification of these latest cases does not change the overall risk assessment, which remains moderate at both the global and regional levels. 

These cases show that the virus continues to pose a threat in countries where it is circulating in dromedary camels, with regular spillover into the human population. 

WHO recommends implementation of targeted infection, prevention and control (IPC) measures to prevent the spread of health care-associated infections of MERS-CoV and onward human transmission.

Description of the situation

Since the first report of MERS-CoV in the KSA and Jordan in 2012, a total 2635 laboratory-confirmed cases of MERS-CoV infection, with 964 associated deaths (Case Fatality Ratio (CFR) of 37%), have been reported to WHO from 27 countries, across all six WHO regions (...). 

The majority of cases (84%; n=2224), have been reported from the KSA (...). 

Since the beginning of 2025 and as of 21 December, a total of 19 cases have been reported to WHO. 

Overall, 17 cases were reported in the KSA from five regions named: Riyadh (n=10), Taif (n=3), Najran (n=2), Hail (n=1), and Hafr Al-Batin City (n=1) (...). 

In addition, two travel associated cases of MERS-CoV infection have been reported in France, with likely exposure occurring during recent travel in the Arabian Peninsula (...). 

This disease outbreak news report focuses on the recent nine cases of MERS-CoV infection reported between 4 June - 21 December 2025: seven cases from the KSA and the two imported cases to France. 

The details of cases reported earlier in 2025 can be referred to in the previously published disease outbreak news on 13 March 2025 and 12 May 2025.

Between 4 June and 21 December 2025, the MoH of the KSA reported a total of seven cases of MERS CoV infection. 

The cases were reported from three regions: Najran (2), Riyadh (3), and Taif (2). 

No epidemiological links were identified between the seven cases. 

In addition, between 2 and 3 of December 2025, the IHR NFP for France reported two cases of MERS – CoV with recent travel to the Arabian Peninsula during the month of November.

Follow-up has been completed for all contacts and no secondary infections have been identified or reported. 

From September 2012, France has recorded a total of four laboratory-confirmed cases of MERS-CoV infection, including one death: two cases were reported in 2013, and the latest two cases in December 2025. 

All cases had been travelers exposed in the Arabian Peninsula and returning back to France.

(...)

Epidemiology

Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The case fatality ratio (CFR) among confirmed cases is around 37%. The CFR is calculated based solely on laboratory-confirmed infections and may overestimate the actual mortality rate since milder cases often go undetected or unreported.

Humans can contract MERS-CoV through multiple transmission pathways; the primary route being through direct or indirect contact with dromedary camels, which serve as the virus’s natural host and primary zoonotic reservoir. 

Additionally, human-to-human transmission can occur via infectious respiratory particles primarily in close-contact situations and can also occur through direct or indirect contact; this is especially prominent in health-care settings. 

Human-to-human transmission of the virus has occurred in health care facilities in several countries, including transmission from patients to health care providers and transmission between patients before MERS-CoV was diagnosed. 

It is not always possible to identify patients with MERS‐CoV early or without testing because symptoms and other clinical features may be non‐specific. 

Outside these environments, there has been limited documented human-to-human transmission. 

MERS can present with no symptoms (asymptomatic), mild symptoms (including mild respiratory issues), or severe illness leading to acute respiratory distress and death. 

Common symptoms include: 

- fever, 

- cough, and 

- breathing difficulties, 

- with pneumonia frequently observed, though not always present. 

Some patients also experience gastrointestinal symptoms such as diarrhoea. 

Severe cases may require intensive care, including mechanical ventilation. 

Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders.

The number of MERS-CoV infections reported to WHO substantially declined since the beginning of the COVID-19 pandemic. 

Initially, this was likely the result of epidemiological surveillance for SARS-CoV-2 being prioritized. 

Similar clinical pictures of both diseases may have resulted in reduced testing and detection of MERS-CoV infections. 

However, the MoH of the KSA has been working to improve testing capacities for better detection of MERS-CoV since the easing of the COVID-19 pandemic, with MERS-CoV included into sentinel surveillance testing algorithms since the second quarter of 2023, for samples that test negative for both influenza and SARS-CoV-2. 

In addition, recommended IPC measures (e.g., mask-wearing, hand hygiene, physical distancing, improving ventilation) and public health and social measures in the community to reduce SARS-CoV-2 transmission, (stay-at-home orders, reduced mobility) also likely reduced onward human-to-human transmission of respiratory infections including MERS-CoV. 

Potential cross-protection conferred from infection with or vaccination against SARS-CoV-2 and any reduction in MERS-CoV infection or disease severity and vice versa has been hypothesized but requires further investigation. [1,2]  

Public health response

WHO is supporting Member States in strengthening preparedness and response.

Activities in the Kingdom of Saudi Arabia include:

-- Strengthened surveillance with immediate notification of all suspected and confirmed cases.

-- Strict implementation of infection prevention and control transmission-based precautions (Contact and Droplet precautions) in healthcare facilities for suspect or confirmed patients, and airborne precautions for patients undergoing aerosol-generating procedures.

-- Identification of health and care worker contacts and perform risk assessment of their exposure, considering the timely identification of symptomatic patients, implementation of IPC measures, and correct utilization of PPE while treating patients,

-- Exposed health and care workers are followed up for 14 days to monitor symptoms. If they develop symptoms, they are to be removed from working with patients until tested and symptoms are fully resolved.

-- Patients exposed to MERS-CoV in the healthcare setting must be tested to determine their ability to continue working with patients without further transmission, which could potentially lead to outbreaks in the healthcare facility. 

-- Identification of all potential community contacts and active follow-up to monitor symptoms for 14 days.

-- All community acquired cases are investigated for having direct or indirect contact with camels or their products.

-- Cases linked to camel exposures are notified to the National Center for Prevention and Control of Plants, Pests, and Animal Diseases (Weqaa) to investigate potential camel sources.

-- Camels identified as a presumed source are quarantined and tested for MERS-CoV, and if live virus is detected, the quarantine period will be extended until live virus is no longer detected in camel.

Activities in France include:

-- On 4 December 2025, MoH France published information regarding the two imported cases of MERS-CoV in the country.

-- Genomic sequencing was conducted from the first case and reported as being the same lineage that is circulating in the Arabian Peninsula. Further laboratory analyses are ongoing.

-- Contact tracing was initiated as soon as the first case was detected for the monitoring and surveillance of fellow travellers and co-exposed individuals, high-risk contacts, and hospital contacts. It was completed in week 51 and no additional cases among the travellers have been reported, nor any secondary cases as of 19 December 2025. 

-- Asymptomatic co-exposed individuals and at-risk contacts located in France were offered a full testing protocol (nasopharyngeal swab, sputum, rectal swab and serology) on a voluntary basis up to 29 days after their last exposure, even if they did not exhibit any symptoms.

WHO risk assessment

As of 21 December 2025, a total of 2635 laboratory-confirmed cases of MERS-CoV infection have been reported globally to WHO, with 964 associated deaths. 

The majority of these cases have occurred in countries on the Arabian Peninsula, including 2224 cases with 868 related deaths (CFR 39%) reported from the KSA.

A notable outbreak outside the Middle East occurred in the Republic of Korea, in May 2015, during which 186 laboratory-confirmed cases (185 in the Republic of Korea and 1 in China) and 38 deaths were reported. However, the index case in that outbreak had a history of travel to the Middle East.

Three limited healthcare-related clusters have recently been reported from the KSA, two in 2024 comprised of three and two cases each, and one in 2025 comprised of 7 cases; the previous cluster before that had been observed in May 2020, also in the KSA. 

Extensive contact tracing was applied in the 2025 cluster, which lead to detection of four asymptomatic and two mild cases, who fully recovered. 

Despite these recent clusters, zoonotic spillover remains an important mode of human infection, leading to isolated cases and limited onwards transmission between humans.

Global total cases reflect laboratory-confirmed cases reported to WHO under IHR (2005) or directly by Ministries of Health from Member States. These figures may underestimate the true number of cases if some were not reported to WHO, as they may be missed by current surveillance systems and not be tested for MERS-CoV – either due to similar clinical presentation as other circulating respiratory diseases or because infected individuals remained asymptomatic or had only mild disease. The total number of deaths includes those officially reported to WHO through follow-up with affected Member States. 

The notification of these new cases does not change the overall risk assessment. 

WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (for example, consumption of raw camel milk,  camel urine, or eating meat that has not been properly cooked), or in a healthcare setting. 

Due to the similarity of symptoms with other respiratory diseases that are widely circulating, like influenza or COVID-19, detection and diagnosis of MERS cases may be delayed, especially in unaffected countries, and provide an opportunity for onward human-to-human transmission to go undetected. 

WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.  

No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. 

Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.

WHO advice

-- Surveillance:

- Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, with the inclusion of MERS-CoV into the testing algorithm where warranted, and to carefully review any unusual patterns.  

-- Clinical Management:

- The incubation period is typically 2-15 days (median 5 days), although prolonged incubation periods have been reported in the immunocompromised. 

- Although mild disease does occur, clinicians should be aware that symptoms may frequently progress rapidly non-specific signs of upper respiratory tract infection, cough and breathlessness, to respiratory failure and cardiovascular collapse.[3]

- MERS-CoV infection should be managed supportively with respiratory support titrated to the needs of the patient; there is a wide spectrum of severity, with many patients requiring mechanical ventilation.

- The largest clinical trial in MERS compared a combination of lopinavir–ritonavir and interferon β-1b with placebo (95 patients).[4] 

- Active treatment caused lower 90-day mortality in hospitalized patients with laboratory-confirmed MERS (90-day mortality of 48% and 29% respectively). 

- Further analysis suggested a positive effect only in patients treated within 7 days of symptom onset. 

- Although there is increasing use of corticosteroids for some respiratory conditions (specifically in COVID-19 and some other forms of pneumonia), their use in MERS-CoV is of uncertain benefit, and harms relating to their immunomodulatory effects may be significant; more data are needed. 

- The use of convalescent plasma has not been proven, although has been used in a limited number of patients in a non-trial setting. 

- While antibiotics have been used in severe disease to presumptively treat concurrent bacterial infection, there are no controlled data on efficacy. 

- A retrospective analysis of 349 MERS patients examined macrolide antibiotic therapy. No difference in 90-day mortality was found in the 136 patients receiving macrolides compated with those who did not.[5]

-- Infection prevention and control:

- Human-to-human transmission of MERS-CoV in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing timely IPC measures. 

- IPC measures are therefore critical to prevent the spread of MERS-CoV in healthcare facilities and onwards in the community. 

- Healthcare workers should always apply standard precautions consistently with all patients and perform risk assessments at every interaction in healthcare settings to determine the necessary protection measures. 

- For patients with suspected MERS-CoV infection that require hospitalization, place patient in an adequately ventilated single room away from other patient care areas. 

- In addition to standard precautions. Droplet and contact precautions should be implemented when providing care to patients with symptoms of acute respiratory infection who are suspects of any respiratory disease, including probable or confirmed cases of MERS-CoV infection.[6,7]

- Droplet and contact precautions should be maintained until the patient is no longer symptomatic (for at least 24 hours) and has two upper respiratory (URT) swabs (taken 24hrs apart) test negative in RT-PCR or according to local guidance. 

- Additionally, airborne precautions should be applied when performing aerosol generating procedures or in settings where aerosol generating procedures are conducted. 

- Early identification, case management and prompt isolation of suspected respiratory infected patients and cases, quarantine of contacts, together with appropriate IPC measures in health care settings, including improving ventilation in enclosed spaces and public health awareness can prevent the spread of human-to-human transmission of MERS-CoV. 

-- Public health and social measures:

- MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunosuppression. 

- Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating.

- General hygiene measures, such as regular hand hygiene before and after touching animals or animal products and avoiding contact with sick animals, should be adhered to. 

- In addition, hygiene practices should be observed including the five keys to safer food should be followed when dealing with food items of camels; people should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked. 

- WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions. 

Further information

-- Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection:interim guidance: updated October 2019.   [Internet]. [cited 2025 Dec 10]. Available from: https://iris.who.int/handle/10665/174652

-- Transmission-based precautions for the prevention and control of infections: aide-memoire [Internet]. [cited 2025 Dec 10]. Available from: https://iris.who.int/handle/10665/356853.

-- Standard precautions for the prevention and control of infections: aide-memoire.[cited 2025 Dec 10] Available from https://iris.who.int/handle/10665/356855

-- MERS fact sheet, updated 11 December 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)

-- 2015 MERS outbreak in Republic of Korea [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/westernpacific/emergencies/2015-mers-outbreak

-- WHO MERS-CoV dashboard. [cited 2025 Dec 10]. Available from: https://data.who.int/dashboards/mers

-- Disease Outbreak News [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/emergencies/disease-outbreak-news

-- EPI-WIN webinar: MERS-CoV, a circulating coronavirus with epidemic and pandemic potential - Pandemic preparedness, prevention and response with a One Health approach [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/news-room/events/detail/2023/05/24/default-calendar/epi-win-webinar-mers-cov-a-circulating-coronavirus-with-epidemic-and-pandemic-potential-pandemic-preparedness-prevention-and-response-with-a-one-health-approach

-- MERS Outbreak Toolbox [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/mers-outbreak-toolbox

-- Middle East Respiratory Syndrome (MERS) | Policy&Services : KDCA [Internet]. [cited 2025 Dec 10]. Available from: https://www.kdca.go.kr/contents.es?mid=a30329000000

-- Middle East respiratory syndrome: global summary and assessment of risk - 16 November 2022 [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/publications/i/item/WHO-MERS-RA-2022.1

-- OpenWHO.org - Middle East respiratory syndrome [Internet]. [cited 2025 Dec 10]. Available from: https://openwho.org/channel/Middle+East+respiratory+syndrome/574814

-- Practical manual to design, set up and manage severe acute respiratory infections facilities [Internet]. [cited 2025 Dec 10]. Available from: https://iris.who.int/items/eb2cb9aa-ef45-4952-8307-a00cbeee70a6

-- Strategic plan for coronavirus disease threat management: advancing integration, sustainability, and equity, 2025–2030 [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/publications/i/item/9789240117662

-- Update 88: MERS-CoV, a circulating coronavirus with epidemic and pandemic potential - Pandemic preparedness, prevention and response with a One Health approach [Internet]. [cited 2025 Dec 10]. Available from: https://www.who.int/publications/m/item/update-88-mers-cov-a-circulating-coronavirus-with-epidemic-and-pandemic-potential-pandemic-preparedness--prevention-and-response-with-a-one-health-approach

-- WHO EMRO - MERS outbreaks [Internet]. [cited 2025 Dec 10]. Available from: https://www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html?format=html 

References:

[1] AlKhalifah, J. M., Seddiq, W., Alshehri, M. A., Alhetheel, A., Albarrag, A., Meo, S. A., Al-Tawfiq, J. A., & Barry, M. (2023). Impact of MERS-CoV and SARS-CoV-2 Viral Infection on Immunoglobulin-IgG Cross-Reactivity. Vaccines, 11(3), 552. https://doi.org/10.3390/vaccines11030552

[2] Zedan, H. T., Smatti, M. K., Thomas, S., Nasrallah, G. K., Afifi, N. M., Hssain, A. A., Abu Raddad, L. J., Coyle, P. V., Grivel, J. C., Almaslamani, M. A., Althani, A. A., & Yassine, H. M. (2023). Assessment of Broadly Reactive Responses in Patients With MERS-CoV Infection and SARS-CoV-2 Vaccination. JAMA network open, 6(6), e2319222. https://doi.org/10.1001/jamanetworkopen.2023.19222

[3] Middle East respiratory syndrome, Memish, Ziad A et al. The Lancet, Volume 395, Issue 10229, 1063 – 1077

[4] Arabi, Y. M., Asiri, A. Y., Assiri, A. M., Balkhy, H. H., Al Bshabshe, A., Al Jeraisy, M., Mandourah, Y., Azzam, M. H. A., Bin Eshaq, A. M., Al Johani, S., Al Harbi, S., Jokhdar, H. A. A., Deeb, A. M., Memish, Z. A., Jose, J., Ghazal, S., Al Faraj, S., Al Mekhlafi, G. A., Sherbeeni, N. M., Elzein, F. E., … Saudi Critical Care Trials Group (2020). Interferon Beta-1b and Lopinavir-Ritonavir for Middle East Respiratory Syndrome. The New England journal of medicine, 383(17), 1645–1656. https://doi.org/10.1056/NEJMoa2015294

[5] Macrolides in critically ill patients with Middle East Respiratory Syndrome, Arabi, Yaseen M. et al., International Journal of Infectious Diseases, Volume 81, 184 - 190

[6] Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Available at https://www.who.int/publications/i/item/10665-174652

[7] Transmission-based precautions for the prevention and control of infections: aide-memoire. Available at: https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.2

Citable reference: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON591

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON591

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#France, Two imported cases of MERS-CoV identified on national territory (Min. Santé, Dec. 4 '25)

{Automatic translation}

The Ministry of Health, Families, Autonomy and Persons with Disabilities and Public Health France have been informed of two cases of MERS-CoV in France. 

These two cases were confirmed following suggestive symptoms and a history of shared travel to the Arabian Peninsula. 

Management measures have been implemented to limit the risk of virus transmission.

Stéphanie Rist, Minister of Health, Families, Autonomy and Persons with Disabilities, confirms: “These patients are being monitored in hospital as a precautionary measure and their condition is stable. All management measures have been put in place to limit the risk of transmission of the virus to the patients' contacts and healthcare staff: contact tracing to offer them follow-up, barrier gestures, testing, isolation and procedures to follow in case of the appearance of symptoms, even mild ones.”

These two cases occurred in individuals who had participated in the same trip, but no secondary transmission chains have been identified within the country at this stage. 

The other individuals who participated in the trip have also been monitored since the identification of the first confirmed case.

If you experience these symptoms and have recently traveled to these areas and/or have been in contact with people who have experienced these symptoms, do not hesitate to consult your doctor.

What is MERS-CoV?

MERS-CoV (Middle East Respiratory Syndrome Coronavirus) is a virus that was first identified in Saudi Arabia in 2012 and is primarily transmitted from animals to humans . The virus is endemic to dromedary camels and bats in the Arabian Peninsula and parts of Africa. It is transmitted through direct or indirect contact (consumption of raw or contaminated animal products).

Although rare, human-to-human transmission is possible through direct or indirect contact, via respiratory droplets, and occasionally through the air. This mainly concerns healthcare workers performing medical procedures when treating cases, or people living in the same household. The risk of human-to-human transmission in the general population is low . The incubation period is 5 to 15 days.

The symptoms of the disease are nonspecific: fever, cough, difficulty breathing, and sometimes gastrointestinal problems. Treatment is based on addressing these symptoms.

Epidemiological data on MERS-CoV

In France, until now only two cases had been recorded in 2013: the first in a traveler returning from abroad, the second in a patient who shared a hospital room with that person. Since 2012 and as of November 3, 2025, 2,640 cases of MERS-CoV have been recorded worldwide.

To learn more:

Pasteur Institute

· World Health Organization

· European Centre for Disease Prevention and Control (ECDC)

Press contacts:

Secretariat of Ariane Vincent, Press and Communication Advisor,

Ministry of Health, Families, Autonomy and Persons with Disabilities.

Office of Ms. Stéphanie Rist.

Tel: +33 1 87 05 97 89.

Email: sec.presse.sfaph@sante.gouv.fr

Public Health France:

Email: presse@santepubliquefrance.fr

Source: 

Link: https://sante.gouv.fr/actualites-presse/presse/communiques-de-presse/article/deux-cas-de-mers-cov-de-retour-de-l-etranger-identifies-sur-le-territoire

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Recurrent #MERS-CoV #Transmission in #Saudi Arabia– Renewed Lessons in #Healthcare #Preparedness and Surveillance

{Excerpt}

The World Health Organization (WHO) had recently announced on May 12, 2025, the reporting of nine new laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Saudi Arabia [1]. This announcement is a sobering reminder that while the global community remains focused on emergent threats like avian influenza or post-pandemic resilience, endemic zoonotic diseases like MERS-CoV may continue to circulate, evolve, and exploit gaps in infection prevention.

(...)

Source: Journal of Epidemiology and Global Health, https://link.springer.com/article/10.1007/s44197-025-00426-6

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Middle East respiratory syndrome #coronavirus {#MERS-CoV} - Kingdom of #Saudi Arabia (#WHO D.O.N., May 12 '25)

Situation at a glance

Between 1 March and 21 April 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported nine cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Two of these cases died. Among the nine cases, a cluster of seven cases were identified in Riyadh, including six health and care workers who acquired the infection from caring for a single infected patient. The cluster was identified through contact tracing and subsequent testing of all contacts, with four of the six health and care workers being asymptomatic and two showing only mild, nonspecific signs. The notification of these cases does not change the overall risk assessment, which remains moderate at both the global and regional levels. These cases show that the virus continues to pose a threat in countries where it is circulating in dromedary camels and spilling over into the human population. WHO recommends implementation of targeted infection prevention and control (IPC) measures to prevent the spread of health-care-associated infections of MERS-CoV and onward human transmission.

Description of the situation

Between 1 March and 21 April 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported nine cases of MERS-CoV infection. 

The cases were reported from the Hail (1) and Riyadh (8) regions of Saudi Arabia (Figure 1). Of the reported cases, five were male and four were female.

Among these cases, a cluster of seven was identified in Riyadh, including six health and care workers who acquired a nosocomial infection from one single infected patient they had cared for. 

Of the six health and care workers, four remained asymptomatic, while two developed mild, nonspecific symptoms including myalgia, fatigue, nausea and vomiting (...). 

Laboratory confirmation of the cases was performed by real-time polymerase chain reaction (RT-PCR) between 1 March 2025 and 16 April 2025. 

Of the cases, only one had indirect contact with camels and is not a part of the reported cluster. The rest of the patients had no known history of contact with camels or camel products.

Since the first report of MERS-CoV in KSA in 2012, a total 2627 laboratory-confirmed cases of MERS-CoV infection, with 946 associated deaths (Case Fatality Rate or CFR of 36%), have been reported to WHO from 27 countries, across all six WHO regions. 

The majority of cases (2218; 84%), have been reported from KSA, including these newly reported cases (...). Since 2019, no human MERS-CoV infections have been reported from countries outside the Middle East.

(...)

Epidemiology

Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. The CFR is calculated based solely on laboratory-confirmed infections, which may not reflect the correct mortality rate.

Humans contract MERS-CoV through direct or indirect contact with dromedary camels, the virus’s natural host and zoonotic reservoir. 

Human-to-human transmission occurs via infectious respiratory particles mainly at close distances and also through contact transmission, it has mainly occurred in close-contact situations, particularly in health-care settings. 

Outside these environments, there has been limited documented human-to-human transmission to date. 

MERS can present with no symptoms, mild respiratory issues, or severe illness leading to acute respiratory distress and death. 

Common symptoms include fever, cough, and breathing difficulties, with pneumonia frequently observed, though not always present. 

Some patients also experience gastrointestinal symptoms such as diarrhoea. 

Severe cases may require intensive care, including mechanical ventilation. Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders.

The number of MERS-CoV infections reported to WHO has substantially declined since the beginning of the COVID-19 pandemic. 

Initially, this was likely the result of epidemiological surveillance for SARS-CoV-2 being prioritized. 

The similar clinical picture of both diseases may result in reduced testing and detection of MERS-CoV infections. 

However, the Ministry of Health of KSA has been working to improve testing capacities for better detection of MERS-CoV since the easing of the COVID-19 pandemic, with MERS-CoV included into sentinel surveillance testing algorithms since the second quarter of 2023, for samples that test negative for both influenza and SARS-CoV-2. 

In addition, measures taken to reduce SARS-CoV-2 transmission (e.g., IPC measures such as mask-wearing, hand hygiene, physical distancing, improving the ventilation of indoor spaces, respiratory etiquette, stay-at-home orders, reduced mobility) also likely reduced opportunities for onward human-to-human transmission of MERS-CoV. 

Potential cross-protection conferred from infection with or vaccination against SARS-CoV-2 and any reduction in MERS-CoV infection or disease severity and vice versa has been hypothesized but requires further investigation.

No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.

Public health response

The Ministry of Health of KSA implemented the following response measures

-- Infection prevention and control (IPC) measures in healthcare settings:

- Regular training of health and care workers on IPC measures.

- Implementation of stringent IPC measures, including triage protocols, use of personal protective equipment (PPE), and isolation procedures for suspected cases.

- Prompt isolation of cases and quarantine of contacts.

-- Surveillance and testing:

- Rigorous contact tracing and testing of high-risk contacts, including healthcare workers.

- Inclusion of MERS-CoV in sentinel surveillance testing algorithms since 2023.

-- Public health awareness and hygiene practices:

- Public health awareness campaigns to prevent human-to-human transmission.

- Advising people with underlying chronic medical conditions to avoid close contact with animals, particularly dromedaries.

WHO risk assessment

As of 21 April 2025, a total of 2627 laboratory-confirmed cases of MERS-CoV infection have been reported globally to the WHO, with 946 associated deaths. 

The majority of these cases have occurred in countries within the Arabian Peninsula, with 2218 cases (84.4%) and 865 related deaths (CFR 39%) reported from the KSA. 

A notable outbreak outside the Middle East occurred in the Republic of Korea, in May 2015, during which 186 laboratory-confirmed cases (185 in the Republic of Korea and 1 in China) and 38 deaths were reported. However, the index case in that outbreak had a travel history to the Middle East. 

The global case count reflects laboratory-confirmed cases reported to WHO under IHR (2005) or directly by Ministries of Health to date. These numbers may underestimate the true number of cases if some were not reported. The total number of deaths includes those that WHO has been officially informed of, based on follow-up with affected Member States. 

Humans are infected with MERS-CoV from direct or indirect contact with dromedaries who are the natural host and zoonotic source of the MERS-CoV infection. MERS-CoV has demonstrated the ability to be transmitted between humans. 

So far, the observed non-sustained human-to-human transmission has occurred among close contacts and in health care settings. Outside of the healthcare setting there has been limited human-to human transmission.  

The notification of these cases does not change the overall risk assessment. The reported cluster of six secondary cases among health and care workers is the result of rigorous contact tracing and testing performed by KSA, with four of the six cases being asymptomatic and two showing only mild, unspecific signs. 

WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (for example, consumption of raw camel milk), or in a healthcare setting. 

WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.  

WHO advice

Based on the current situation and available information, WHO reemphasizes the importance of strong surveillance by all Member States for acute respiratory infections, including MERS-CoV where warranted, and to carefully review any unusual patterns. 

Delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing IPC measures have been linked with human-to-human transmission of MERS-CoV in health-care settings in past outbreaks. IPC measures are therefore critical to prevent the spread of healthcare-associated infections of MERS-CoV. Health and care workers should always apply standard precautions consistently with all patients, at every interaction in healthcare settings.

Ventilation rates in general patient care rooms should meet or exceed 60 litres per second per patient (or 6 air changes per hour). 

In addition, contact and droplet precautions, which include patient placement in single rooms with dedicated care equipment, and the use of personal protective equipment (PPE) such as clean non-sterile gown, gloves, eye protection and a well-fitting medical mask, should be added to standard precautions when providing care to patients with suspected or confirmed MERS-CoV. 

Airborne precautions should be added when performing aerosol-generating procedures or in settings where aerosol-generating procedures are conducted, including the use of procedure rooms with ventilation rates meeting or exceeding 160 litres per second (or 12 air changes per hour). 

Early identification, case management and prompt isolation of cases, quarantine of contacts, together with appropriate IPC measures in health care settings and public health awareness can prevent human-to-human transmission of MERS-CoV. 

MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating.

General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. 

In addition to contact with animals, hygiene practices should be observed when dealing with food items of camels; people should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked. 

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions.

(...)

Citable reference: World Health Organization (12 May 2025). Disease Outbreak News; Middle East Respiratory Syndrome coronavirus – Kingdom of Saudi Arabia. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON569

Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON569

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Invasive #meningococcal #disease - Kingdom of #Saudi Arabia (WHO D.O.N.)

{Excerpts}

Situation at a glance

On 13 March 2025, the International Health Regulations (IHR) National Focal Point (NFP) for the Kingdom of Saudi Arabia (KSA) reported 11 cases of invasive meningococcal disease (IMD) to WHO. Additionally, between 11 February and 18 March 2025, the WHO Eastern Mediterranean Regional IHR contact point received reports of six isolated cases of IMD, either through notification or bilateral communication with IHR NFPs. These cases involve individuals who had recently returned from Umrah. Meningococcal disease remains a global public health concern, particularly in the context of mass gathering events such as Hajj and Umrah. The government of Saudi Arabia regularly issues health requirements for Hajj and Umrah, including vaccination policies. As of 10 March 2025, KSA health authorities estimated that only 54% of international Umrah pilgrims had complied with the meningococcal vaccination requirements. The significant number of pilgrims traveling to KSA from countries with varying levels of meningococcal disease incidence presents a risk of international spread during these gatherings. Given the recent notification of these cases linked to Umrah, WHO strongly advises all individuals planning to attend mass gatherings such as Hajj and Umrah to receive vaccination against meningococcal disease at least 10 days prior to travel.

Description of the situation

On 13 March 2025, the NFP for KSA reported to WHO 11 confirmed cases of IMD. All cases were associated with individuals who had performed Umrah in KSA between 7 January and 12 March 2025.

Among the 11 confirmed cases, four were reported from three countries in the WHO Eastern Mediterranean Region, while the remaining cases are individuals with travel history from countries in the WHO South-East Asia Region. The median age of cases was 36 years (range 6 – 69 years) and 64% were male. The cases were diagnosed between 7 January and 2 March 2025, and none of the affected individuals had a history of vaccination against meningococcal disease. All cases received treatment in hospitals in KSA, fully recovered and were discharged. Serogrouping tests identified the causative strain as Neisseria meningitidis (N. meningitidis) serogroup W135.

In addition, between 11 February and 18 March 2025, the WHO Eastern Mediterranean Regional IHR contact point received reports—either through notifications or bilateral communication with IHR NFPs —of six isolated cases of IMD among individuals who had recently returned from Umrah. Of these, three cases were reported from the WHO Europe Region and three cases were from the WHO Eastern Mediterranean Region. The median age of cases was 19 years (range 6 – 30 years). Serogroup W135 was confirmed in two of the six cases. 

Epidemiology

Invasive meningococcal disease is a life-threatening bacterial infection caused by Neisseria meningitidis, associated with severe long-term complications and a high case fatality rate, despite prompt and appropriate treatment.

Meningococcal disease occurs worldwide, and can present as a sporadic, clustered or epidemic-prone infection with varying degrees of endemicity across regions. Outbreaks are more likely to occur in settings that facilitate transmission of infection, such as areas with low vaccination coverage, overcrowded living conditions, limited or disrupted access to healthcare services, and mass gatherings, including religious pilgrimages like Hajj and Umrah.  In the KSA, public health authorities conduct regular risk assessments and continue to identify meningococcal disease as a significant public health threat during mass gatherings. Thus, the requirement of quadrivalent meningococcal vaccination (MenACWY), which protects against serogroups A, C, W, and Y, prior to traveling to KSA for Hajj and Umrah has been maintained in the previous years.  However, vaccination compliance for Umrah was declined over the past two years.

The significant number of pilgrims arriving in KSA from countries with diverse meningococcal disease prevalence increases the risk of international spread. In 2024, 12 cases of meningococcal disease associated to Umrah and/or pilgrimage to KSA were reported from the United States of America, the United Kingdom, and France. Of these, nine patients were unvaccinated, and the vaccination status of remaining three was unknown. 

Antimicrobial susceptibility data was available for 11 of the 12 cases, and ciprofloxacin-resistant strains were identified in three cases. In 2025, to date, 17 cases associated with travel to KSA for religious pilgrimage have already been reported from multiple countries.

Public health response

-- Leadership and coordination:

- Disseminating guidelines: The government of Saudi Arabia regularly issues the health requirements for Hajj and Umrah, which are published on the Ministry of Health (MoH) website and disseminated to all countries through diplomatic channels. A key requirement is that all travelers must receive the MenACWY vaccine before departing from their home country for Umrah and Hajj.

Surveillance:

- Screening at Points of Entry: Health authorities at Saudi Arabia's points of entry conduct screenings during the Hajj and Umrah seasons by visually checking for signs and symptoms of invasive IMD among incoming travelers. They also review travelers' health documents to ensure compliance with the required health protocols.

- Conducting regular risk assessments: Public health authorities in Saudi Arabia regularly conduct risk assessments. The country has strengthened surveillance for IMD in the Umrah zone, and continuously monitors Neisseria meningitidis carriage in both Makkah and Madinah.

- Electronic surveillance system: Saudi Arabia has established a comprehensive electronic surveillance system to monitor and control IMD across all healthcare facilities. This system mandates the immediate reporting of all suspected and confirmed cases to public health authorities. Standardized case definitions are provided to ensure accurate and timely identification. Laboratory-based diagnostics, including culture, antimicrobial susceptibility testing, and PCR, are prioritized, along with the collection of detailed demographics, clinical, and epidemiological data to support response efforts. Active surveillance is particularly heightened during mass gatherings to quickly detect and respond to potential outbreaks.

-- Clinical operations:

- Case management: Healthcare facilities in Saudi Arabia are well-prepared to effectively manage cases of meningococcal disease and their close contacts. This is ensured through the provision of appropriate medical care, including timely diagnosis and prompt treatment, based on the appropriate use of antibiotics. Infection prevention and control practices are followed to minimize the risk of nosocomial (hospital-acquired) transmission.

- Post-exposure chemoprophylaxis: Chemoprophylaxis is an essential preventive measure against meningococcal disease. Antimicrobial prophylaxis is administered to close contacts of confirmed cases to prevent secondary transmission. The selection of the drug of choice should be guided by known antimicrobial resistance patterns.

- Vaccination: Targeted vaccination with a conjugate vaccine is used to prevent disease in the community. Most adults in the Umrah region had received at least one dose of the conjugate vaccine, in addition to routine meningococcal immunization for children.

- Risk communication and community engagement:

- Awareness campaigns: Saudi Arabia places strong emphasis on public education and community engagement to promote early detection, timely treatment, and prevention of meningococcal disease. Awareness campaigns are regularly conducted to inform the public on the nature of the disease, its symptoms, and the importance of early medical intervention. These campaigns also highlights the critical role of vaccination, both as part of the national immunization programme and as a mandatory requirement for Hajj and Umrah pilgrims.

WHO risk assessment

Meningococcal disease remains a public health challenge, especially for mass gathering events like Hajj and Umrah.

Umrah is a year-round pilgrimage to Mecca in KSA. The risk of meningococcal disease at mass gatherings like Hajj and Umrah is increased due to the high population influx, the person-to-person transmission through respiratory droplets, and the presence of pilgrims from diverse geographical regions and prolonged close contact—resulting from shared accommodations and participation in rituals. In 2024, it was estimated that 24 million pilgrims performed Umrah, with 50% of those being international pilgrims. Mass gatherings such as those occurring during the Umrah pilgrimage can facilitate the transmission of infectious diseases, including IMD.

Since 2001, strict preventative measures, including mandatory quadrivalent (MenACWY) meningococcal vaccination has mitigated the risk of pilgrimage-associated meningococcal outbreaks. While MenACWY vaccination is highly effective in reducing the risk of outbreaks during Hajj and preventing transmission to the home countries of pilgrims, there are challenges in ensuring the vaccination of the pilgrims in their countries of origin since the compliance with the public health advisory is voluntary. As of 10 March, it was estimated by KSA health authorities that only 54% of international Umrah pilgrims have complied with the meningococcal vaccination requirements.  As returning travelers may spread the disease to their local communities, this risk is further heightened when there is lower compliance with meningococcal vaccination among pilgrims.  

Preparedness and surveillance efforts must be maintained year-round, with particular emphasis during peak periods like Ramadan and school holidays that often see a sharp increase in pilgrim numbers. In addition, the risk of importation of meningococcal disease is increased during the epidemic season in the countries of the African meningitis belt (i.e. December through June), several of which are home to large Muslim populations. This potentially affects not only the pilgrims but also other travelers (including those traveling for non-religious purposes) and the wider community.

Another risk factor is the emergence of antibiotic resistance for N. meningitidis strains to fluoroquinolones (ciprofloxacin) and potentially third generation cephalosporins, which can complicate post-exposure prophylaxis and treatment options for individuals with IMD. The growing influx of tourists and relatively long incubation period may account for increased risk of international spread.

WHO advice

Meningococcal disease remains a key public health concern at mass gatherings such as Hajj and Umrah. Despite mandatory vaccination policies, declining compliance in recent years has increased transmission risks.

Preventive and control measures should focus on:

- Ensuring high vaccination coverage before travel.

- Enhancing timely detection, investigation and management of cases and their close contacts.

- Enhancing real-time surveillance and monitoring antimicrobial resistance trends.

- Strengthening risk communication and community engagement to improve compliance.

- Strengthening vaccination coverage and compliance for Umrah travelers

WHO strongly advises individuals attending mass gatherings such as Hajj and Umrah to receive vaccination against meningococcal disease at least 10 days prior to travel. This measure is considered the most effective strategy to prevent the disease and potential outbreaks during these events. Specifically, WHO recommends that all pilgrims receive the quadrivalent meningococcal conjugate vaccine, which covers serogroups A, C, W, and Y, prior to traveling.​

The authorities of KSA require incoming pilgrims to hold proof of vaccination with quadrivalent meningococcal conjugate vaccine ACWY. This, and other health related entry requirements, are available on the official web site of the Ministry of Health of Saudi Arabia and other governmental platforms. States Parties shall make aware immigration authorities and conveyance operators of health-related requirements implemented by the Saudi Arabia, so that the validity of heath documents carried by travelers to Saudi Arabia can be duly checked before departure and prior to arrival in Saudi Arabia.

Promotion of coordination among ministries of health, civil aviation, immigration authorities, and Hajj/Umrah tour operators to ensure harmonized implementation of vaccination and entry requirements, including pre-departure checks.

Enhancing timely case detection, investigation, and management:

Timely detection and confirmation as well as prompt, appropriate management of cases are critical control measures against meningococcal disease. Suspected cases should undergo laboratory confirmation, which requires the isolation of N. meningitidis from a normally sterile body fluid, including blood, cerebrospinal fluid, or less commonly, pleural, pericardial or synovial fluid. Confirmatory tests include culture with antimicrobial susceptibility testing as well as molecular investigations (e.g. PCR).

Antibiotic therapy, typically administered for a total duration of 5 to 7 days, is the cornerstone of treatment. Empiric therapy with intravenous ceftriaxone or cefotaxime should be initiated in suspected cases as soon as possible. Once N. meningitidis is isolated, the antibiotic regimen should be reviewed and adjusted according to AST results.

Individuals with prolonged exposure while in close proximity to an index case and as well as those directly exposed to their oral secretions are at increased risk of infection. Post-exposure antibiotic prophylaxis is therefore recommended for close contacts as a measure to prevent secondary transmission and eradicate asymptomatic nasopharyngeal carriage. Considering the rising concerns related to ciprofloxacin-resistance among  N. meningitidis isolates, the drug of choice for post-exposure prophylaxis should be selected based upon prevalent antimicrobial resistance patterns. Pre-exposure antimicrobial prophylaxis is not recommended.  

Review and update contact tracing guidance for meningococcal infections on aircraft to ensure alignment with best practices. The RAGIDA (Risk Assessment Guidelines for Infectious Diseases Transmitted on Aircraft) framework from ECDC provides valuable guidance and can serve as a reference.

Expand the digital health passport system to include comprehensive vaccination records, ensuring all required immunization data for pilgrims is current and verifiable.

Strengthening surveillance:

WHO emphasizes the importance of robust surveillance systems for meningococcal disease to effectively control and prevent outbreaks and to continue sharing information between concerned health authorities. Host countries should conduct ongoing surveillance and rely on a risk-based approach focused on the evaluation, mitigation, and communication of risk to ensure timely and appropriate public health responses.

WHO also highlights the importance of monitoring antibiotic resistance trends by systematically testing N. meningitidis isolates in order to adequately inform post-exposure prophylaxis and treatment strategies. Available information pertaining to serogroups and genomic sequencing should be timely shared with global surveillance platforms in order to track strain variations and identify potential clusters.

Risk communication and community engagement:

Awareness of requirements through policy briefs to Ministers of Health should be undertaken, emphasizing the critical role of vaccination in preventing outbreaks.

Risk communication should be undertaken to raise community awareness and boost coverage by: Engaging religious leaders (e.g., mosque imams) to advocate for vaccination within Muslim communities, including during the Friday Prayer Khutba. Other RCCE measures could include: disseminate vaccination requirements through Hajj/Umrah tour operators, mosques, embassies, and airports; work with religious leaders (e.g., imams) to promote health messaging, especially during sermons and gatherings such as Friday prayers; ensure vaccination messaging is clearly visible on official websites (e.g., Saudi MoH, embassies) and in travel documents; launching public awareness campaigns to emphasize the importance and effectiveness of vaccination in preventing meningococcal disease, utilizing social media, traditional media, and community outreach initiatives.

An information note should be provided to close contacts to raise awareness about the signs and symptoms of disease, along with contact details for reaching health authorities.  

WHO does not recommend any restriction on travel and/or trade to the Kingdom of Saudi Arabia on the basis of the information available for the current event.

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Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON563

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#MERS #coronavirus - Kingdom of #Saudi Arabia

Situation at a glance

This is the bi-annual update on the Middle East respiratory syndrome coronavirus (MERS-CoV) infections reported to the World Health Organization (WHO) from the Kingdom of Saudi Arabia (KSA). 

From 6 September 2024 to 28 February 2025, four laboratory-confirmed cases of MERS-CoV infection, including two deaths, were reported to WHO by the Ministry of Health of the KSA. 

One of the four cases was a secondary case exposed to the virus in a healthcare facility (nosocomial transmission). 

Close contacts of the four cases were followed up by the Ministry of Health. 

No additional secondary cases have been detected. 

The notification of these four cases does not alter the overall risk assessment, which remains moderate at both the global and regional levels. 

The reporting of these cases shows that the virus continues to pose a threat in countries where it is circulating in dromedary camels, particularly those in the Middle East.

Description of the situation

Between 6 September 2024 and 28 February 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported four cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths, with the last case being reported on 4 February 2025. 

The cases were reported from the Hail (2), Riyadh (1) and the Eastern (1) Provinces of the KSA (...). 

Laboratory confirmation of the cases was performed by real-time polymerase chain reaction (RT-PCR) between 8 November 2024 and 4 February 2025.

All cases involved males aged between 27 and 78 years, and all presented with comorbidities. None were health workers, and from investigations only one was found to have indirect contact with dromedary camels (hosts of MERS-CoV) and their raw products (milk).

Two cases, with symptoms onset in November 2024, were identified within the same hospital. 

The first case was confirmed on 11 November through RT-PCR testing, and follow-up on close contacts revealed a secondary case that shared the same hospital room and developed symptoms subsequently. 

Neither of the two patients had direct or indirect contact with dromedary camels, including consumption of raw camel milk in the 14 days prior to the onset of symptoms.

Since the first report of MERS-CoV in KSA in 2012, a total 2618 laboratory-confirmed cases of MERS-CoV infection, with 945 associated deaths (CFR 36%), have been reported to WHO from 27 countries, across all six WHO regions. 

The majority of cases (2209; 84%), have been reported from KSA, including these newly reported cases. Since 2019, no MERS-CoV infections have been reported from countries outside the Middle East.

(...)

Epidemiology

Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. The case fatality ratio (CFR) is calculated based solely on laboratory-confirmed infections, which may not reflect the correct mortality rate.

Humans contract MERS-CoV through direct or indirect contact with dromedary camels, the virus’s natural host and zoonotic reservoir. While human-to-human transmission is possible, it has mainly occurred in close-contact situations, particularly in healthcare settings. Outside these environments, there has been limited human-to-human transmission to date.

MERS can present with no symptoms, mild respiratory issues, or severe illness leading to acute respiratory distress and death. Common symptoms include fever, cough, and breathing difficulties, with pneumonia frequently observed, though not always present. Some patients also experience gastrointestinal symptoms such as diarrhoea. Severe cases may require intensive care, including mechanical ventilation. Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders.

The number of MERS-CoV infections reported to WHO has substantially declined since the beginning of the COVID-19 pandemic. Initially, this was likely the result of epidemiological surveillance activities for COVID-19 being prioritized. The similar clinical picture of both diseases may result in reduced testing and detection of MERS-CoV infections. In addition, measures taken to reduce SARS-CoV-2 transmission (e.g., mask-wearing, hand hygiene, physical distancing, improving the ventilation of indoor spaces, respiratory etiquette, stay-at-home orders, reduced mobility) also likely reduced opportunities for onward human-to-human transmission of MERS-CoV. Potential cross-protection conferred from infection with or vaccination against SARS-CoV-2 and any reduction in MERS-CoV infection or disease severity and vice versa has been hypothesized but requires further investigation.

No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.

Public health response

Apart from the two cases linked to healthcare settings, the Ministry of Health did not detect any additional secondary infections. Triage for respiratory diseases has been implemented in the concerned hospital to enable early detection of patients with respiratory symptoms. In addition, comprehensive refresher training on the case definition has commenced for all health and care workers to ensure early detection of cases.

WHO risk assessment

The notification of these four additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (consumption of raw camel milk), or in a healthcare setting. WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, including MERS-CoV, and to carefully review and investigate any unusual patterns.

Human-to-human transmission of MERS-CoV in health care settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, delayed triage of suspected cases, and delays in implementing infection prevention and control (IPC) measures. IPC measures are critical to prevent the possible spread of MERS-CoV between people in health care facilities. Health workers should consistently apply standard precautions, including risk assessment for any new onset of symptoms of respiratory infections, consistently with all patients, at every interaction in health-care settings.

Contact and droplet precautions, which include patient placement in single rooms with dedicated care equipment, and the use of personal protective equipment (PPE) such as clean non-sterile gown, gloves, eye protection and a well-fitting medical mask, should be added to standard precautions when providing care to patients with MERS-CoV. Ventilation rates in patient care rooms should meet or exceed 60 litres per second per patient (or 6 air changes per hour). Airborne precautions should be applied when performing aerosol-generating procedures or in settings where aerosol-generating procedures are conducted, including the use of procedure rooms with ventilation rates meeting or exceeding 160 litres per second (or 12 air changes per hour). Early identification, case management and isolation of cases, quarantine of contacts, together with appropriate IPC measures in health-care settings and public health awareness can prevent human-to-human transmission of MERS-CoV. 

MERS-CoV infection appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and in immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating. General hygiene measures should be adhered to, such as regular hand washing before and after touching animals and avoiding contact with sick animals. 

Food hygiene practices should be observed. People should avoid drinking raw camel milk, contact with camel urine or eating camel meat that has not been thoroughly cooked. The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from pathogens that may cause disease in humans. Animal products that are processed appropriately through cooking or pasteurization are safe for consumption. Foods that have gone through these processes should be handled with care to avoid cross contamination with uncooked/unsafe foods. Camel meat and camel milk are nutritious products that can continue to be consumed after cooking, pasteurization or other thermal treatments. 

WHO does not advise special screening at points of entry regarding this event, nor does it currently recommend the application of any travel or trade restrictions.

(...)

Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON560

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