On July 24, 2023, the World Health Organization confirmed a case of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Abu Dhabi, the United Arab Emirates (UAE). A confirmed case of MERS-CoV was reported to WHO on July 10, 2023, by the International Health Regulations National Focal Point of the UAE.
The number of confirmed MERS-CoV cases reported to WHO since 2012 is 2605, including 936 associated deaths. Prior to this new case, the last reported MERS-CoV case from the UAE was in November 2021. Outside this area, there was a big outbreak in the Republic of Korea in May 2015, with 186 laboratory-confirmed cases.
MERS is a viral respiratory infection of humans and dromedary camels that is caused by the MERS-CoV coronavirus. Humans are infected with MERS-CoV through direct or indirect contact with dromedary camels, who are the natural host and zoonotic source of the MERS-CoV infection. Humans are infected with MERS-CoV from direct or indirect contact with dromedaries, a host and zoonotic source of MERS-CoV infection. It has been demonstrated that MERS-CoV is capable of being transmitted between humans. Until now, the nonsustained human-to-human transmission has occurred among close contacts and in healthcare settings. There has been limited human-to-human transmission outside the healthcare setting.
MERS-CoV infections range from asymptomatic or mild respiratory symptoms to severe acute respiratory disease and death. Fever, cough, and shortness of breath are common symptoms of MERS-CoV infection. Pneumonia is a common, but it not always present. Additionally, gastrointestinal symptoms, including diarrhea, have been reported. It appears that the virus causes more severe disease in older people, people with weakened immune systems and those with chronic diseases such as renal disease, cancer, chronic lung disease, and diabetes. A severe illness can result in respiratory failure, which requires mechanical ventilation and support in an intensive care unit, leading to a high mortality rate.
Description of the case
The patient is a 28-year-old male, non- Emirati national, and he is not employed in the health care field. Between 3 and 7 June 2023, he visited a private medical center multiple times and complained of vomiting, right flank pain, and dysuria. On June 8, he was admitted to government hospital because of vomiting, and gastrointestinal symptoms including diarrhea. The initial diagnosis was acute pancreatitis, acute kidney injury, and sepsis. The patient has no known co-morbidities.
On June 13, he was in a critical condition and was referred to an intensive care unit, where he was placed on mechanical ventilation. A nasopharyngeal swab was collected on June 21 and tested positive for MERS-CoV by PCR on June 23, 2023.
The patient has no history of contact with human cases of MERS-CoV, and no recent travel outside the UAE. He also has no known history of direct contact with animals including dromedary camels, nor consumption of their raw products.
This is a severe case with no comorbidities or history of exposure to camels, camel raw products or MERS-CoV human case. Therefore, the WHO recommended sequencing the virus and conducting genomic analysis to screen for any unusual patterns.
In addition, a total of 108 contacts from health care facilities were found and tested for MERS-CoV. All the results were negative. All 108 contacts were monitored for 14 days from the last date of exposure to the patient. So far, there have been no secondary cases.
The 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. Furthermore, it is anticipated that individuals who have been exposed to the virus through contact with dromedaries or their products (for example, consumption of camel’s raw milk), or in a healthcare setting will continue to export cases to other countries.