Summary assessmentWHO’s assessment of the situation remains largely unchanged since the previous summary of 17 May.
The newest cases reported indicate that the source of infection, which has still not been determined, remains active in the Middle East and is present throughout a large area. The first case in Tunisia was likely infected in Qatar; however, this cannot be definitively shown without further investigation. Both the Tunisian and Qatari public health authorities are pursuing further investigations.
The appearance of cases in Europe and North Africa but not in other countries with frequent travel in and out of the Middle East is likely a result of differences in surveillance and testing. All Member States are encouraged to remind travelers returning from the affected area to seek medical attention if they develop a respiratory illness, and to test those who meet the profile described in the current surveillance recommendations posted on the WHO coronavirus website.
Human-to-human transmission has not been observed to persist beyond small clusters of individuals with close contact. However, it is likely that more sporadic cases with subsequent limited transmission will occur in the near future. The large number of cases with reported co-morbidities suggests that persons with underlying medical conditions may have increased susceptibility to infection. Health care facilities treating patients suspected of being infected with MERS-CoV should exercise appropriate infection control measures. Clinicians should be aware that MERS-CoV infection may present atypically, and initially without respiratory symptoms, in immunocompromised individuals.
Member States are reminded that lower respiratory specimens should be used for diagnosis in addition to nasopharyngeal swabs when they are available. If a nasopharyngeal swab tests negative, consider retesting using lower respiratory specimens such as sputum, endotracheal aspirate, or bronchoalveolar lavage. Clinicians should take care to follow strict infection prevention and control guidelines when collecting respiratory specimens of any kind. Recommendations on laboratory testing for novel coronavirus, including specimen collection and transportation, should be followed and can be found at: