Since April 2012, 157 laboratory-‐confirmed and 19 probable cases of human infection with Middle East respiratory syndrome coronavirus (MERS-‐CoV) have been reported to WHO. Three new countries—Spain, Kuwait, and Oman—have reported patients with MERS-‐CoV since the last update. Infections in Kuwait and Oman were likely acquired locally, while the two probable cases reported by Spain were both recent travellers to the Middle East. The cases in Spain have not yet been confirmed, pending finalization of the laboratory testing. To date, affected countries in the Middle East include Jordan, Kingdom of Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman and Kuwait. Europe countries reported include: France, Germany, the United Kingdom (UK), Italy and Spain, and in North Africa: Tunisia (Figure 1).
Eighteen of the 27 new cases reported since the last update cases were sporadic, that is, cases that were reported to have no prior contact with another known case and including cases that were the first case within a cluster. Seven cases reported contact with previous confirmed cases and two are unclassified due to lack of information.
Of note, all four recently confirmed cases from Qatar were reported to have farm contact. The first case was a 61-‐year-‐old Qatar national without history of travel or contact with confirmed cases. The farms include a variety of animals, including camels, sheep and poultry. The second case is a 23-‐year-‐ old male resident who worked on the farm owned by the first case. He displayed very mild symptoms and was discovered as part of contact screening. The third and fourth cases are a 48-‐year-‐ old man and a 61-‐year-‐old man, respectively. Both had no history of contact with previously laboratory-‐confirmed cases but a preliminary investigation indicated that they had frequent interactions with farm animals. A comprehensive investigation into animal exposures of the cases has been launched by the Supreme Council of Health of Qatar.
On 10 November 2013, the Ministry of Health of Saudi Arabia announced the detection of MERS-‐CoV in a specimen taken from an ill camel owned by a laboratory-‐confirmed case from Jeddah. This case had direct contact with the ill camel. If confirmed, this will represent the first detection of MERS-‐CoV in camels.
Of the 176 laboratory-‐confirmed and probable reported cases to date, 69 (39.2%) have died and 65.3% of those for which sex is known were male (111/170). The median age of the cases with reported age is 51 years (range 14 months -‐ 94 years; n=172). Sporadic cases (n=62) are more likely to be male (76% vs. 58%) and above the age of 50 years old (66% vs. 39%) compared with secondary cases (n=97).