UPDATE ON

MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS-CoV)

30 DECEMBER 2014
I.

WHO Update on MERS-CoV:

Globally from September 2012 to date, 941 laboratory-confirmed
cases of MERS-CoV infection including 347 related deaths have
officially been reported to the World Health Organization (WHO).
The virus appears to be circulating widely throughout the Arabian
Peninsula and most MERS cases have been reported by the Kingdom
of Saudi Arabia. While most cases have occurred among residents,
some cases have occurred among visitors. Based on currently available
information, the overall risk for visitors to acquire MERS-CoV infection
appears to be low.
The currently known epidemiological patterns indicate some infections
occur in communities. Cases detected in the community may arise from
contact with infected animals or unprocessed products from infected
animals, from person-to-person spread in the community or from
acquisition in the healthcare setting by individuals who remained living
in the community.
Meanwhile, the following are countries that reported laboratoryconfirmed case(s) of MERS-CoV infection:
Region
Middle East

Countries
Iran
Jordan
Kingdom of Saudi Arabia
Kuwait
Lebanon
Oman
Qatar
United Arab Emirates (UAE)
Yemen

Region
Africa

Asia
Europe

North America
II.

Countries
Algeria
Egypt
Tunisia
Malaysia
Philippines
Austria
France
Greece
Germany
Italy
Netherlands
Turkey
United Kingdom (UK)
United States of America (USA)

MERS-CoV Infection in Malaysia:

On 14 April 2014, the first case of MERS-CoV was confirmed in
Malaysia in a man in his mid-fifties, who developed pneumonia with
respiratory distress, after returning from a pilgrimage to the Kingdom of
Saudi Arabia. The case succumbed to his illness three days after
admission at a local hospital. Follow-up of the close contacts identified
through contact tracing and vigilant surveillance did not result in
detecting any other confirmed cases of MERS-CoV.

III.

Recommendations:
a)

Based on the current situation and available information, it is

recommended to continue surveillance for severe acute
respiratory infections (SARI) and to carefully review any unusual
patterns.

b)

Health care providers are advised to maintain vigilance. Recent

travelers returning from the Middle East who develop sARI should
be tested for MERS-CoV as advised in the current surveillance
recommendations.

c)

Patients should be managed as potentially infected when the

clinical and epidemiological clues strongly suggest MERS-CoV,
2

even if an initial test on a nasopharyngeal swab is negative.

Repeat testing should be done when the initial testing is negative,
preferably on specimens from the lower respiratory tract.
Clinicians are also reminded that MERS-CoV infection should be
considered even with atypical signs and symptoms, such as
diarrhea, in patients who are immunocompromised.
d)

Infection prevention and control measures are critical to prevent

the possible spread of MERS-CoV in health care facilities. 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. Health care workers
should be educated, trained and refreshed with skills on infection
prevention and control.
It is not always possible to identify patients with MERS-CoV early
because some have mild or unusual symptoms. For this reason, it
is important that health care workers apply standard precautions
consistently with all patients regardless of their diagnosis in all
work practices all the time.

e)

Recent investigative findings increasingly support the hypothesis

that camels are an important source of exposure to MERS-CoV in
the community. Based on the available information, it is prudent
for people at high risk of severe disease due to MERS-CoV
infection, including those with diabetes, chronic lung disease, preexisting renal failure or those who are immune-compromised, to
take appropriate precautions when visiting farms, barn areas or
market environments where camels are present. These measures
might include avoiding contact with camels, good hand hygiene
and avoiding drinking raw milk or eating food that may be
contaminated with animal secretions or products unless they are
properly washed, peeled or cooked.

f)

The World Health Organization (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.

g)

It is encourages to raise awareness of this travel advice to reduce

the risk of MERS-CoV infection among pilgrims and those
associated with their travel, including transport operators and
ground staff and about self-reporting of illness by travellers.

DISEASE CONTROL DIVISION

MINISTRY OF HEALTH MALAYSIA
30 DECEMBER 2014