Thursday, November 7, 2013

ECDC Updated Rapid Risk Assessment #MERS #Coronavirus - November 6, 2013

[editing below is mine]

Source  and  date  of  request  ECDC  internal  decision,  6  November  2013.

ECDC  internal  response  team    
Denis  Coulombier,  Tarik  Derrough,  Josep  Jansa,  Kaja  Kaasik-­Aaslav,  Daniel  Palm,  Pasi  Penttinen,  Juliana  Reyes-­ Uruena,  Bertrand  Sudre.
Acknowledgements:  Coordinating  Centre  for  Health  Alerts  and  Emergencies,  Madrid,  Spain 

Public Health Issue
This  eighth  update  of  the  rapid  risk  assessment  of  the  MERS-­CoV  outbreak  is  intended  to  provide  expert  opinion  on   the  risk  for  Europe  with  regards  to  the  probable  case  of  MERS  reported  by  Spain  on  5  November. 

Event Background
On  6  November  2013,  Spain  reported  a  case  of  MERS-­CoV  infection  in  a  61-­year-­old  female  with  no  known  chronic   conditions.  She  stayed  in  Saudi  Arabia  from  2  October  to  1  November  2013,  initially  in  Medina,  then  in  Mecca  for   the  Hajj.  No  contacts  with  animals  or  confirmed  cases  were  reported.  
She  flew  from  Jeddah  to  Madrid  on  1  November  2013.
The  onset  of  symptoms  was  reported  as  of  15  October  2013  (cough,  fever)  and  she  was  seen  at  the  emergency   ward  in  Mecca  Hospital  on  28  and  29  October  where  pneumonia  was  diagnosed  through  chest  x-­ray.  
During  the  return  flight  she  was  symptomatic  and  required  oxygen  while  in  the  aircraft.  She  was  taken  to  a   hospital  in  Madrid,  admitted  with  the  diagnosis  of  pneumonia  and  isolated  as  per  guidelines.  This  patient  is  now  in   a  stable  condition.
On  5  November  2013,  initial  PCR  laboratory  test  for  MERS-­CoV  screening  was  positive  on  three  different  samples.   Further  tests  for  case  confirmation  are  pending.  
On  6  November,  the  Spanish  authorities  implemented  contact-­tracing  activities  around  family  members  of  the  case,   healthcare  personnel  and  patients  that  had  been  in  close  contact  with  the  case.  Passengers,  as  well  as  staff  and   crew  from  the  airline,  that  had  been  in  close  contact  with  the  case  are  also  being  traced.  Naso-­pharyngeal  samples   will  be  collected  from  them.  No  residents  from  other  EU/EEA  countries  appear  to  be  on  the  list  of  passengers   seated  within  two  rows  of  the  index  case.

Epidemiological  situation  worldwide
As  of  7  November  2013,  there  have  been  151  laboratory-­confirmed  cases  of  MERS-­CoV  worldwide,  including  64   deaths.  All  cases  have  either  occurred  in  the  Middle  East  or  have  had  direct  links  to  a  primary  case  infected  in  the   Middle  East.

Saudi  Arabia  has  reported  125  symptomatic  and  asymptomatic  cases  including  53  deaths;;  Jordan  two  cases,  both   of  whom  died;;  United  Arab  Emirates  five  cases,  including  one  fatality;;  Qatar  five  cases,  including  two  deaths;;  and   Oman  one  case.  

Thirteen  cases  have  been  reported  from  outside  the  Middle  East:  in  the  UK  (4),  France  (2),  Tunisia  (3),  Germany   (2),  Italy  (1)  and  Spain  (1).
ECDC  risk  assessment  for  the  EU

This  is  the  13th  case  reported  outside  of  the  Middle  East,  the  tenth  reported  in  EU/EEA  Member  States,  the  first   reported  in  Spain  and  the  first  reported  in  the  EU/EEA  Member  States  since  May  2013.

This  case  would  correspond  to  an  imported  case  in  the  EU,  following  exposure  in  Saudi  Arabia  and  being   symptomatic  during  the  Hajj.  The  risk  that  the  EU  would  see  importation  of  new  cases  was  stressed  in  the  ECDC   rapid  risk  assessment  published  on  24  September,  and  therefore,  this  situation  was  expected.
The  Spanish  authorities  have  implemented  tracing  activities  consistent  with  WHO  and  ECDC  recommendations.   Therefore,  the  risk  for  further  spread  in  the  EU/EEA  countries  is  considered  extremely  low.    

The  first  case  of  MERS-­CoV  infection  reported  in  Spain  should  remind  EU  citizens  of  the  risk  for  contracting  MERS-­ CoV  through  exposure  while  travelling  to  the  Middle  East.  As  indicated  in  previous  risk  assessments,  such  cases  are   expected  to  be  reported  in  the  EU,  and  in  particular,  among  pilgrims  returning  from  the  Hajj.  

EU/EEA  Member  States  are  investigating  potential  cases  presenting  suggestive  symptoms  on  return  from  the   Middle  East.  Until  this  case,  all  investigations  turned  out  to  be  negative,  but  this  finding  confirms  the  need  to   pursue  efforts  to  rapidly  investigate  possible  cases.

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