MERS-CoV: the global epidemiology
Republic of Lebanon
Ministry of Public Health
Epidemiological Surveillance Program
May 2014
Sources
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WHO: www.who.int
CDC: www.cdc.gov
ECDC: www.ecdc.europa.eu
world map: http://coronamap.com/
Outline
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Total count
By time
By place
By person
Travel advice
Total count
• Since April 2012 to 08 May 2014
– 536 laboratory-confirmed cases of MERS-CoV
– including 145 deaths
• To date, the affected countries
– Middle East; Jordan, Kuwait, Oman, Qatar, Saudi Arabia (KSA),
United Arab Emirates (UAE) and Yemen
– Africa: Egypt and Tunisia
– Europe: France, Germany, Greece, Italy and the United Kingdom
– Asia: Malaysia and Philippines
– North America: the United States of America (USA).
• All of the cases recently reported outside the Middle East
recently travelled from countries inside of the Middle East
(KSA or UAE).
Source: WHO
Time: Epidemic Curves
Confirmed cases by country of presumed exposure
Source: WHO
Time: Epidemic Curves
Confirmed cases by outcome
Source: WHO
Time: Epidemic Curves
Epidemic Curve by Case-Type (Primary vs. Secondary)
Source: WHO
Place: of onset (up to 16May 2014)
Source: ECDC
Place: of onset (up to 16May 2014)
Source: ECDC
Place: place of exposure
Cases by
country of
probable
exposure
Source: WHO
Place: place of exposure
Source: WHO
Place: place of exposure
Source: ECDC
Place: World map
Source: http://coronamap.com
Person
• Gender: 66% of cases are male
• Median age is 49 years old (range 9 months94 years old)
• Primary < secondary cases
Person
Source: ECDC
Person
Characteristics of primary vs secondary cases*
*Table includes cases with reported information on each variable; 234 cases have missing information about case type
Primary
Cases
Secondary
Cases
98
204
57.5 (2-90)
39 (9m-94)
% of male cases
80% (78/97)
56% (111/198)
% of cases with ≥1 underlying condition reported
84% (74/88)
69% (66/96)
% of cases classified as fatal
83% (48/58)
45% (33/74)
% Severe
91% (88/97)
27% (53/198)
% Asymptomatic
0
5% (2/41)
33% (23/70)
42% (84/198)
63% (93/147)
9% (3/32)
Characteristic
n
Median age in years (range)
% Health care workers
% reported contact with camels
Source: WHO
WHO Travel Advice 1
• At this time, the risk to an individual pilgrim of
contracting MERS-CoV is considered very low.
• WHO does not recommend the application of
any travel or trade restrictions or entry screening.
• Before departure, pilgrims should be advised:
– Pre-existing major medical conditions can increase the
likelihood of illness, including MERS-CoV infection,
during travel
– Pilgrims should consult a health care provider to
review the risk and assess whether making the
pilgrimage is advisable
WHO Travel Advice 2
• Dissemination of general travel health
precautions, which will lower the risk of infection
in general.
• Specific emphasis should be placed on:
– Washing hands often with soap and water , or with
hand rub
– Adhering to good food-safety practices (avoiding
undercooked meat or food prepared under unsanitary
conditions, and properly washing fruits and
vegetables before eating them)
– Maintaining good personal hygiene
– Avoiding unnecessary contact with farm, domestic,
and wild animals
WHO Travel Advice 3
• Travelers who develop a significant ARI with
fever and cough (severe enough to interfere
with usual daily activities) should be advised
to:
– Minimize their contact with others
– Adopt cough etiquette: Cover their mouth and
nose with a tissue when coughing or sneezing and
discard the tissue in the trash after use and wash
hands afterwards, or, if this is not possible, to
cough or sneeze into upper sleeves of their
clothing, but not their hands
– Report to the medical staff
WHO Travel Advice 4
• Patients:
– Returning pilgrims developing a significant ARI with fever
and cough during the two weeks after their return should
seek medical attention.
– Persons who have had close contact with a pilgrim or
traveler with a significant ARI with fever and cough and
who themselves develop such an illness should seek
medical attention.
• Clinicians:
– Practitioners and facilities should be alerted to the
possibility of MERS-CoV infection in returning pilgrims with
ARI, especially those with fever and cough and pulmonary
parenchymal disease
– If clinical presentation suggests the diagnosis of MERS-CoV,
laboratory testing, should be done and infection
prevention and control measures implemented.