The Min­istry of Health in Saudi Ara­bia has noti­fied WHO of an addi­tional laboratory-confirmed case of infec­tion with the Mid­dle East res­pi­ra­tory syn­drome coro­n­avirus (MERS-CoV). The fatal case was reported from Al-Qaseem region in the Cen­tral part of the coun­try and is not related to the clus­ter of cases reported from Al-Ahsa region in the East­ern part of the coun­try. The patient was a 63-year-old man with an under­ly­ing med­ical con­di­tion who was admit­ted to a hos­pi­tal with acute res­pi­ra­tory dis­tress on 15 May 2013 and died on 20 May 2013. Inves­ti­ga­tion into con­tacts of this case is ongoing.

The Saudi author­i­ties are also con­tin­u­ing the inves­ti­ga­tion into the out­break that began in a health care facil­ity since the begin­ning of April 2013 in Al-Ahsa. As of 23 May 2013, a total of 22 patients includ­ing 10 deaths have been reported from the out­break. Glob­ally, from Sep­tem­ber 2012 to date, WHO has been informed of a total of 44 laboratory-confirmed cases of infec­tion with MERS-CoV, includ­ing 22 deaths.

WHO has received reports of laboratory-confirmed cases from the fol­low­ing coun­tries in the Mid­dle East: Jor­dan, Qatar, Saudi Ara­bia, and the United Arab Emi­rates (UAE). France, Ger­many, Tunisia and the United King­dom also reported laboratory-confirmed cases; they were either trans­ferred for care of the dis­ease or returned from Mid­dle East and sub­se­quently became ill. In France, Tunisia and the United King­dom, there has been lim­ited local trans­mis­sion among close con­tacts who had not been to the Mid­dle East but had been in close con­tact with the laboratory-confirmed or prob­a­ble cases.

Based on the cur­rent sit­u­a­tion and avail­able infor­ma­tion, WHO encour­ages all Mem­ber States to con­tinue their sur­veil­lance for severe acute res­pi­ra­tory infec­tions (SARI) and to care­fully review any unusual pat­terns. Health care providers are advised to main­tain vig­i­lance. Recent trav­ellers return­ing from the Mid­dle East who develop SARI should be tested for MERS-CoV as advised in the cur­rent sur­veil­lance rec­om­men­da­tions. Spec­i­mens from patients’ lower res­pi­ra­tory tracts should be obtained for diag­no­sis where pos­si­ble. Clin­i­cians are reminded that MERS-CoV infec­tion should be con­sid­ered even with atyp­i­cal signs and symp­toms, such as diar­rhea, in patients who are immuno­com­pro­mised. Health care facil­i­ties are reminded of the impor­tance of sys­tem­atic imple­men­ta­tion of infec­tion pre­ven­tion and con­trol (IPC). Health care facil­i­ties that pro­vide care for patients sus­pected or con­firmed with MERS-CoV infec­tion should take appro­pri­ate mea­sures to decrease the risk of trans­mis­sion of the virus to other patients, health care work­ers and visitors.

All Mem­ber States are reminded to promptly assess and notify WHO of any new case of infec­tion with MERS-CoV, along with infor­ma­tion about poten­tial expo­sures that may have resulted in infec­tion and a descrip­tion of the clin­i­cal course. Inves­ti­ga­tion into the source of expo­sure should promptly be ini­ti­ated to iden­tify the mode of expo­sure, so that fur­ther trans­mis­sion of the virus can be prevented.

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. WHO con­tin­ues to closely mon­i­tor the situation.

WHO novel coro­n­avirus sum­mary and lit­er­a­ture update avail­able at http://www.who.int/csr/disease/coronavirus_infections/update_20130517/en/index.html

(WHO 5/23/2013)