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Middle East
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Risk assessment
October 2015
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Citation: Ministry of Health. 2015. Middle East Respiratory Syndrome: Risk assessment.
Wellington: Ministry of Health.
Published in October 2015
by the Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
ISBN 978-0-947491-31-3 (online)
HP 6294
This document is available at health.govt.nz
This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you
are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build
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Contents
Executive summary
v
Hazard identification
1
MERS-CoV
1
Signs and symptoms
1
Transmission
2
Prevention of MERS
2
Current MERS-CoV outbreak
3
Epidemiology and geography of current outbreak
3
Outbreak response
5
Risk to New Zealand from MERS
6
The likelihood of a traveller being exposed to MERS in affected countries
6
The risk of infection following exposure
7
The risk of a person infected with MERS-CoV entering New Zealand
7
The risk of MERS spreading in New Zealand
8
Risk management
9
Reducing exposure to MERS-CoV in an affected country
9
Reducing the risk of a person infected with MERS-CoV entering New Zealand
9
Reducing the risk of MERS spreading in New Zealand
Risk assessments from other jurisdictions
10
11
Australia (12 June 2015)
11
Canada (1 October 2015)
11
United States of America (25 June 2015)
12
United Kingdom (9 September 2015)
12
European Union (27 August 2015)
13
Summary
14
List of Figures
Figure 1:
Confirmed cases of MERS-CoV, 2012–2015
Middle East Respiratory Syndrome: Risk assessment
4
iii
Executive summary
Middle East respiratory syndrome (MERS) is a respiratory disease caused by a novel
coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV).
Between September 2012, when MERS-CoV was first identified in Saudi Arabia, and 1 October
2015, 1593 laboratory-confirmed cases of MERS-CoV infection and at least 568 related deaths in
over 25 countries have been reported to the World Health Organization. More than one third of
cases have occurred since 1 January 2015.
No cases of MERS have been reported in New Zealand.
Growing evidence indicates that the dromedary camel is a host species for the virus and that
camels play an important role as a source of human infection. However, while zoonotic
transmission is likely to be the starting point for most clusters, human-to-human transmission
is the dominant mode of transmission. No sustained human-to-human transmission in the
community has yet been recorded.
Low-level transmission continues in countries on and neighbouring the Arabian Peninsula.
Cases have been exported from that region to a range of other countries.
Nosocomial outbreaks have been reported in Saudi Arabia, the United Arab Emirates and South
Korea. Note that in these nosocomial outbreaks, most cases of transmission occurred before
proper infection prevention and control procedures were applied.
Overall, given the low prevalence of MERS, the risk of being exposed to the virus in an affected
country is considered very low. The risk is slightly higher for health care workers in the most
affected countries. The risk for the health care worker will depend on the health care setting, the
kind of work they are involved in, and whether and how infection prevention and control
measures are being applied.
This risk of MERS being imported to New Zealand is considered to be very low given that only a
small number of people travel to New Zealand from severely affected areas and that New
Zealand is relatively geographically isolated. The risk of MERS-CoV spreading within New
Zealand is considered extremely low, once the virus has been recognised. However, as has been
observed in other countries, imported cases and limited outbreaks are possible.
New Zealand has implemented a number of measures to reduce the risk of MERS being
imported. Specifically, it:

continues to monitor the international MERS situation

made MERS a notifiable and quarantinable disease in September 2013 under the Health Act
1956 (Schedule 1) to facilitate the legal aspects of disease control and risk mitigation

provides guidelines and advice for health professionals

provides information to the general public

provides advice to travellers to and from affected countries about risks, preventive strategies
and signs/symptoms of illness
Middle East Respiratory Syndrome: Risk assessment
v

provides health-related signage and information cards at international ports of entry and is
educating border health protection officers about the illness

has protocols and processes in place, such as the National Health Emergency Plan, the New
Zealand Influenza Pandemic Action Plan, border response plans and local emergency
response plans.
Overall the risk of MERS-CoV to public health in New Zealand remains very low; there is a low
risk of imported cases, and an extremely low risk of spread in the event of an imported case.
Early detection of MERS among travellers from affected countries remains essential. The recent
outbreaks in health care settings in South Korea and Riyadh also highlight the continued risk of
nosocomial transmission and the importance of making a timely diagnosis and implementing
infection prevention and control measures.
A single case of MERS in New Zealand would result in an immediate and comprehensive
response.
vi
Middle East Respiratory Syndrome: Risk assessment
Hazard identification
MERS-CoV

Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that
causes a viral respiratory disease, Middle East respiratory syndrome (MERS).

Coronaviruses are a family of viruses that include the causative agents of many illnesses,
from severe acute respiratory syndrome (SARS) to the common cold.

Approximately 36 percent of reported patients infected with MERS-CoV have died, though
this figure may not take into account those with subclinical infections.

Growing evidence indicates that the dromedary camel is a host species for the MERS-CoV
and that zoonotic transmission is the starting point for most clusters. However, human-tohuman transmission is the most common mode of transmission.

Infected camels frequently show no sign of illness.

Coronaviruses can survive up to 48 hours in the environment; therefore it is important that
the patient environment remains clean. Staff performing environmental cleaning should be
appropriately trained and familiar with donning and removing personal protective
equipment. As coronaviruses have a lipid envelope, a wide range of disinfectants and
detergents is effective.

MERS-CoV samples isolated from cases exported outside of the Middle East have not
demonstrated significant genetic differences from the viruses detected in the Middle East.
Signs and symptoms

The incubation period for MERS is generally four to seven days, with a range of two to
fourteen days.

MERS symptoms commonly include coughing, shortness of breath, pneumonia and fever.
Some cases also report muscle aches and gastrointestinal symptoms such as diarrhoea,
nausea and vomiting. The pathogen has demonstrated a range of symptoms from
asymptomatic infection to respiratory compromise and death. Symptoms tend to be more
severe in the elderly, the immunocompromised and those with chronic illnesses.

Severe illness can require intensive care support and mechanical ventilation.

No specific treatment is currently available for MERS. Supportive treatment is offered based
on the clinical condition of the case.
Middle East Respiratory Syndrome: Risk assessment
1
Transmission

MERS-CoV is a zoonotic pathogen. Though the route is not certain, evidence suggests the
virus originated in bats and has been transferred to camels. The virus is now endemic in the
camel populations of the Arabian Peninsula, as well as those in Egypt and Jordan. Humans
seem to be exposed through contact with the fluids or meat of infected camels, alive or dead.
The virus does not seem to pass easily from human to human without close contact. Health
care provision without appropriate personal protective equipment is the most common
method of human-to-human transmission.

Clusters of infections have most commonly occurred in health care settings. Infections in
these settings generally occur in the period before the disease is diagnosed and sufficient
infection control measures are put in place.

Limited human-to-human household transmission of MERS-CoV has been reported.

No transmission of MERS-CoV has been reported on transport, including air transport.

Since 2102 the large majority of cases (over 80 percent) have occurred in Saudi Arabia, with
most other cases occurring in neighbouring nations. The outbreak in South Korea was the
only importation of the illness to a non-Middle Eastern state to evidence significant
secondary transmission.
Prevention of MERS

No vaccine is currently available to protect against MERS-CoV infection. Vaccine trials have
demonstrated efficacy in preventing illness in camels and monkeys.

Visitors to farms, markets or other sites in affected countries where camels and other stock
animals are present should practise good hygiene and wash their hands regularly. Similarly
they should not consume undercooked camel products or unpasteurised milk. These
measures are particularly important for those with chronic illnesses or those who are
immunocompromised.
2
Middle East Respiratory Syndrome: Risk assessment
Current MERS-CoV outbreak
Epidemiology and geography of current
outbreak

Between September 2012, when MERS was first reported, and 1 October 2015,
1593 laboratory-confirmed cases of MERS-CoV infection and at least 568 related deaths have
been reported to the World Health Organization (WHO).

Overall, 65 percent of cases where gender has been reported are male, and the median age is
50 years.

Since 2012, over 25 countries have been affected (Figure 1). Algeria, Austria, China, Egypt,
France, Germany, Greece, Iran, Italy, Kuwait, Lebanon, Malaysia, the Netherlands, Oman,
the Philippines, Thailand, Tunisia, Turkey, the United Kingdom, the United States of
America and Yemen have each had a small number of cases; Jordan, Qatar, the United Arab
Emirates (UAE), South Korea and Saudi Arabia have each had more than 10 cases. More than
two-thirds of diagnosed cases have been in Saudi Arabia.
Middle East Respiratory Syndrome: Risk assessment
3
Figure 1: Confirmed cases of MERS-CoV, 2012–2015
4
Middle East Respiratory Syndrome: Risk assessment
Outbreak response

The WHO does not recommend applying any travel or trade restriction or entry screening
related to MERS. As of 16 June 2015, the WHO has determined that the MERS outbreak has
not met the conditions for a Public Health Emergency of International Concern (PHEIC).

New Zealand’s actions are consistent with this advice. The Ministry of Health website
(http://www.health.govt.nz/our-work/diseases-and-conditions/middle-east-respiratorysyndrome-coronavirus-mers-cov) and the Safe Travel website
(https://www.safetravel.govt.nz/news/middle-east-respiratory-syndrome-coronavirus-merscov)both seek to raise awareness of MERS and its symptoms among those who travel to
affected countries.

The Ministry of Health has provided information to the general public, health sector and
border officials to raise awareness and guide preparedness efforts for the health sector.

With 1593 cases and 568 deaths up to 1 October 2015, and cases reported in several
countries, it is clear that the pathogen is likely to spread sporadically in the future.

The WHO is working with affected countries and partners globally to coordinate surveillance,
research and prevention strategies. Training of health care staff and support for low-resource
states are part of the international effort to stop the pathogen from spreading further.

The WHO is also working with the Food and Agriculture Organization, the World
Organisation for Animal Health, and similar bodies to identify and mitigate the risk factors
related to contact with domesticated animals.

The WHO will continue to assess the situation against the PHEIC criteria, imposing
emergency conditions if the situation warrants.
Middle East Respiratory Syndrome: Risk assessment
5
Risk to New Zealand from
MERS

This section assesses the likelihood of a case of MERS being imported into New Zealand and
the likelihood of MERS-CoV spreading in New Zealand. This assessment takes into account
the likelihood of exposure to the virus in a foreign country and the likelihood of an infected
person arriving in New Zealand.

The risk of MERS being imported into New Zealand is linked to the size and duration of the
outbreak globally.

As the MERS-CoV situation is rapidly changing, this assessment may change with it.
The likelihood of a traveller being exposed to
MERS in affected countries

Saudi Arabia, Jordan, Kuwait, Oman, Qatar, the UAE and Yemen have all reported locally
acquired cases of MERS. Therefore, in these countries there is increased risk of zoonotic
exposure to an environmental source or exposure to a case in a health care setting. Nineteen
other countries have also reported cases. As the situation continues to evolve, it is reasonable
to expect further cases in other countries.

The overall risk of infection for residents or visitors in affected countries is very low. Based on
2013 World Bank data, the affected countries listed above have a combined population of
about 70 million, with approximately 1600 cases having been reported since 2012.

The risk is greatest for those who consume or handle uncooked camel products, come into
contact with camels or use health care facilities in affected countries.

This risk of infection is not limited to hospitals that are currently providing care for MERS
cases, given that cases may initially seek medical attention through any health care provider
before diagnosis.

The increase in the number of MERS cases over recent months, the existence of health care
transmission and the existence of unknown zoonotic transmission chains make it more likely
that residents and travellers in MERS-affected countries will be exposed to infected or ill
people. The risk of infection will continue to increase as the number of cases increases.
6
Middle East Respiratory Syndrome: Risk assessment
The risk of infection following exposure

MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s
respiratory secretions. However, the exact mode of transmission between individuals and
also from animals to people is not clearly understood. MERS-CoV does not appear to be
highly contagious. There has been no known, sustained human-to-human transmission since
the organism was identified.

The role of subclinical infection in transmission of MERS-CoV is also poorly understood.

Human-to-human transmission appears to require close contact with a case, with
transmission being observed among household members, fellow patients and health care
workers. The majority of cases have resulted from human-to-human transmission in health
care settings.

Unlike outbreaks such as SARS, where health care workers were at greatest risk of infection,
MERS-CoV transmission in health care settings has been mostly to other patients at the
facility. While the exact reasons for this pattern are unclear, it suggests that MERS-CoV is
more likely to be transmitted when the exposed person has other health issues.

In summary, while modes of transmission are not entirely clear at this time, the risk of
infection following exposure appears to be greatest in settings where close contact occurs, in
particular in health care settings. Those at greatest risk of infection following exposure in any
setting appear to be those with other underlying health issues.
The risk of a person infected with MERS-CoV
entering New Zealand

Given New Zealand’s geographical isolation, the likelihood of a person infected with MERS
entering New Zealand is low. New Zealand is also not a major destination for travel from the
most affected countries.

There is a theoretical possibility that an infected person could become symptomatic during a
flight to New Zealand. If a traveller on board an aeroplane becomes ill during the flight and is
later diagnosed with MERS, the possibility of transmission to co-passengers and crew should
be assessed. The level of risk will depend on how ill the passenger was during the flight and
who was in contact with them. Note, however, that no cases of transmission between
passengers on an aeroplane have been reported so far.

Given the length of the incubation period, a person infected with MERS-CoV could
theoretically travel to New Zealand before symptoms of the disease start. People travelling to
New Zealand will be offered health information at the border. This measure is meant to
increase the likelihood that a person would report to a health care facility when they
developed symptoms and would be isolated to prevent further transmission.

During the Hajj pilgrimage season each year, a number of New Zealand residents, believed to
number in the low hundreds, travel to Saudi Arabia and other states in the region. Saudi
Arabia makes strenuous efforts to control disease transmission during these times, but the
large number of people gathering in the epicentre of the current outbreak necessarily poses a
risk for spread of the MERS-CoV. New Zealand has addressed this risk by providing general
health education at international airports, as well as yearly reminders and additional
education to border control and health staff.
Middle East Respiratory Syndrome: Risk assessment
7

The Ministry of Foreign Affairs and Trade is currently aware of about 1400 New Zealand
residents visiting, living in and/or working in the Middle East countries that have a high
MERS-CoV incidence. This number is based on individuals who have registered with the Safe
Travel website, which they do voluntarily, and is therefore not likely to reflect the total
number of New Zealand residents in these countries. It is not known how many of these
individuals have either serious ongoing medical conditions or close, frequent contact with
camels, the two greatest risk factors for MERS-CoV infection.

While the risk to New Zealanders in these countries is difficult to quantify, countries such as
the Philippines and India, which have many more expatriates in high-incidence countries in
the Middle East, have not had significant MERS outbreaks. Their experience suggests the risk
of transmission by expatriates or tourists returning home is low.
The risk of MERS spreading in New Zealand

MERS has spread in the most affected countries as a result of repeated exposures to infected
camels and, in the case of the outbreak in South Korea, local traditions regarding seeking
health care.

The risk of MERS spreading within New Zealand is considered extremely low, once MERS
has been recognised.

New Zealand maintains a comprehensive surveillance programme for diseases of concern,
such as MERS, and national reference laboratories to facilitate testing and identification of
organisms.

The probability of sustained chains of MERS-CoV transmission occurring in New Zealand is
extremely low due to the capacity within New Zealand to recognise, identify and isolate
suspected cases, undertake laboratory testing, isolate and treat MERS patients and conduct
contact tracing.

However, if a case infected with MERS-CoV presents in New Zealand, secondary
transmission to caregivers in the family and in health care facilities cannot be excluded,
particularly at an early stage when unprotected contacts are occurring.
8
Middle East Respiratory Syndrome: Risk assessment
Risk management
The following risk management options focus on protecting travellers to affected countries and
minimising the risk of MERS being imported to and spreading in New Zealand.
Reducing exposure to MERS-CoV in an
affected country

The simplest option to reduce exposure to MERS-CoV in the affected countries is to advise
travellers to avoid contact with camels and health care facilities as much as possible. People
with severe chronic illnesses or those who are immunocompromised should take extra
precautions during travel to affected countries.

The Ministry of Health is working with the Ministry of Foreign Affairs and Trade to keep the
Safe Travel website up to date with advice and information to travellers to the affected
countries (www.safetravel.govt.nz).

The overall risk of exposure for residents and travellers through exposure in the community
is considered low if they take the following recommended precautions.
1.
2.
Avoid sites housing camels, and health care settings that have been affected by a
MERS-CoV outbreak.
a.
Avoid direct contact with people who are ill with MERS or unknown illnesses.
b.
Maintain strict standards of hygiene.
Avoid close contact with or handling of camels.
a.
Avoid live camels or undercooked camel products, as both can spread the virus.
b.
Fully cooked or pasteurised camel products should be safe for consumption.
Reducing the risk of a person infected with
MERS-CoV entering New Zealand

No MERS cases have been reported in New Zealand to date.

Given New Zealand is geographically isolated and has a relatively small volume of travel to
and from the Arabian Peninsula, the likelihood of a MERS case entering New Zealand is very
low. The Ministry of Health and local Public Health Unit staff have provided signage to
international airports with advice for travellers who are unwell at arrival or who become
unwell after arrival. Health advice cards in a range of languages are available at international
airports.

Border health protection officers of district health boards have received information
regarding MERS and advice for travellers who become unwell after visiting an affected
country.
Middle East Respiratory Syndrome: Risk assessment
9
Reducing the risk of MERS spreading in
New Zealand

To decrease the risk of MERS spreading in New Zealand, it is important to minimise the time
between the onset of symptoms and the recognition of a suspect case in the health care
system.

Infection prevention and control are crucial to prevent MERS from spreading in health care
settings. Health care staff receive regular training updates on infection prevention and
disease risks.

Infection prevention and control measures available in New Zealand and other measures
such as contact tracing and information for health professionals would greatly limit the risk
of further transmission once a MERS case was identified.

Active monitoring of all close contacts, including in particular staff who have been involved in
the care of MERS patients, would facilitate early detection, isolation and treatment of
secondary cases among health care workers. The Ministry of Health has issued advice to
health professionals that specifically considers managing suspected outbreaks in health care
settings.

New Zealand has established protocols and processes in place, such as the National Health
Emergency Plan, the New Zealand Influenza Pandemic Action Plan (NZIPAP), border
response plans and local emergency response plans. The NZIPAP was developed around a
respiratory disease and will likely be applicable to a MERS-CoV outbreak.

A technical advisory group on infectious disease is being set up to provide the Ministry of
Health with additional expert advice on diseases such as MERS-CoV, as required.
10
Middle East Respiratory Syndrome: Risk assessment
Risk assessments from other
jurisdictions
Australia (12 June 2015)
MERS-CoV is a serious disease that was first identified in September 2012 that results in death
in some people. Most deaths have occurred in people with underlying illnesses that may make
them more likely to get respiratory infections. Other Coronaviruses that are like MERS-CoV
cause the common cold and SARS. All people who have had MERS-CoV have had a history of
living in or travel to the Middle East (mostly Saudi Arabia), contact with travellers returning
from these areas, or can be linked to an imported case. There have been no people with
MERS-CoV in Australia. Doctors and hospitals in Australia are ready to look after a person with
MERS-CoV. Procedures to stop MERS-CoV spreading would include:

Asking a sick person to wear a mask over their mouth and be in a room by themselves.

Laboratory and healthcare workers seeing patients or handling specimens would follow
special safety guidelines.

Health departments would be told that there is a person with MERS-CoV.

Health departments would follow up people who had been in close contact with that person
so they can be given information and be tested if necessary.1
Canada (1 October 2015)

The public health risk posed by MERS-CoV to Canada is considered low based on available
information at this time. The risk may change as new information arises.

MERS-CoV is considered a zoonotic virus that can lead to secondary infections among
people. Many community-acquired infections are thought to be associated with direct or
indirect contact with infected dromedary camels or camel-related products.

Some of the infections have occurred in clusters of close contacts or in health care settings.
This provides good evidence of human-to-human transmission. However, no community
wide transmission has been observed. While human-to-human transmission has been
observed in households in affected countries, most human cases reported to date have
resulted from human-to-human transmission in health care settings.

Additional cases of MERS-CoV infection are expected to be reported from the Middle East.
Additionally, it is likely that cases will continue to be exported to other countries by tourists,
travellers, guest, workers or pilgrims who might acquire infection following exposure to an
animal or human source.2
1
Department of Health, Australia. 2015. Fact sheet for consumers/patients. URL:
www.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov-factsheet-cp.htm (accessed 26 August
2015).
2
Public Health Agency of Canada. 2015. Summary of assessment of public health risk to Canada associated with
Middle East respiratory syndrome coronavirus (MERS-CoV). URL: www.phac-aspc.gc.ca/eriire/coronavirus/risk_assessment-evaluation_risque-eng.php (accessed 6 October 2015).
Middle East Respiratory Syndrome: Risk assessment
11
United States of America (25 June 2015)
The MERS situation in the US represents a very low risk to the general public in this country.
Only two patients in the US have ever tested positive for MERS-CoV infection – both in May
2014 – while more than 500 have tested negative. CDC continues to closely monitor the
situation.
In May 2014, CDC confirmed two unlinked imported cases of MERS in the United States – one
to Indiana, the other to Florida. Both cases were among healthcare providers who lived and
worked in Saudi Arabia. Both travelled to the US from Saudi Arabia, where they are believed to
have been infected. Both were hospitalised in the US and later discharged after fully recovering.
CDC and other public health partners continue to closely monitor the MERS situation. We
recognise the potential for MERS-CoV to spread further and cause more cases in the United
States and globally. In preparation for this, we have:

improved the way we collect data about MERS cases

increased lab testing capacity in states to detect cases

developed guidance and tools for health departments to conduct public health investigations
when MERS cases are suspected or confirmed

provided recommendations for healthcare infection control and other measures to prevent
disease spread

provided guidance for flight crews, Emergency Medical Service (EMS) units at airports, and
US Customs and Border Protection (CPB) officers about reporting ill travellers to CDC

disseminated up-to-date information to the general public, international travellers, and
public health partners

used Advanced Molecular Detection (AMD) methods to sequence the complete virus genome
on specimens from the two US MERS cases to help evaluate and further describe the
characteristics of MERS-CoV. (See Decoding MERS Coronavirus: AMD Provides Quick
Answers.)3
United Kingdom (9 September 2015)
There is a risk of imported cases to the UK, and health professionals should remain vigilant.
Early identification and implementation of infection control measures for suspected cases is
crucial. South Korea will remain as a country within the UK case definition for MERS-CoV until
WHO declare the outbreak as over. This is likely to be 28 days (ie, two times the maximum
incubation period of 14 days) after the last case has tested negative twice.
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.
The probability of MERS-CoV in those who come to the UK from, or return from, the Middle
East, and meet the case definition for a ‘case under investigation’ is low, but requires testing for
MERS-CoV infection.
3
12
Centers for Disease Control and Prevention (CDC). 2015. MERS in the US URL:
www.cdc.gov/coronavirus/mers/us.html (accessed 26 August 2015).
Middle East Respiratory Syndrome: Risk assessment
The probability that a cluster of cases of severe acute respiratory infection of unexplained
aetiology requiring intensive care admission is due to MERS-CoV remains very low, but
warrants investigation and testing. A history of travel to the Middle East or South Korea would
increase the likelihood of MERS-CoV.
The majority of outbreaks of MERS-CoV in the Middle East and South Korea have been linked
to healthcare settings. The WHO has concluded that gaps in infection control measures have
most likely contributed to these outbreaks and has recommended reinforcing the importance of
strict adherence to recommended infection control measures in healthcare facilities.
Therefore, when UK infection control procedures have been followed correctly and promptly,
the probability that a case of acute respiratory infection in a healthcare worker caring for a case
of MERS-CoV is due to MERS-CoV is very low.
The risk will be higher in healthcare workers exposed to MERS-CoV who have not adhered to
UK infection control procedures or not used adequate personal protective equipment.
The risk of MERS-CoV infection in a healthcare worker based in an ICU who meets the case
definition for a ‘case under investigation’ (by virtue of caring for patients with severe acute
respiratory infection regardless of travel history or PPE use) is very low, but warrants testing.
The risk to contacts of confirmed cases of MERS-CoV infection is low but contacts should be
followed up in the 14 days following exposure and any new febrile or respiratory illness
investigated urgently.4
European Union (27 August 2015)
The majority of the MERS cases continue to be reported from the Middle East, and specifically
from Saudi Arabia. Given the substantial number of people travelling between the Middle East
and EU countries, sporadic imported cases to Europe can be expected. In addition to the Hajj,
large numbers of people travel to and from the Middle East throughout the year.
The role of hospitals as amplifiers of MERS-CoV infection is now well known, making the strict
and timely application of comprehensive infection prevention and control measures all the more
imperative.
Sporadic, imported cases can be expected in EU/EEA Member States, and are 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.5
4
Public Health England. 2015. Risk assessment of Middle East respiratory system coronavirus (MERS-CoV). URL:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/461192/MERSCOV_RA_sep_2015_final.pdf (accessed 6 October 2015).
5
European Centers for Disease Prevention and Control (ECDC). 2015. Severe respiratory disease associated with
Middle East respiratory syndrome coronavirus. URL:
http://ecdc.europa.eu/en/publications/Publications/MERS-CoV-rapid-risk-assessment-August-2015.pdf
(accessed 6 October 2015).
Middle East Respiratory Syndrome: Risk assessment
13
Summary
The risk of MERS-CoV to public health in New Zealand is low; there is a low risk of imported
cases, and an extremely low risk of spread in the event of an imported case. It remains essential
to detect MERS-CoV infection early among travellers from affected countries. The recent
outbreaks in health care settings in South Korea and Riyadh also highlight the continued risk of
nosocomial transmission and the importance of timely diagnosis and implementation of
infection prevention and control measures. A single case of MERS-CoV in New Zealand would
result in an immediate and comprehensive response.
This risk assessment may change as the situation continues to evolve.
14
Middle East Respiratory Syndrome: Risk assessment