Situation Report: Middle East Respiratory Syndrome (MERS) in Saudi Arabia

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Saudi Arabia has reported three laboratory-confirmed cases of MERS-CoV, including two deaths, in the last year. The World Health Organization released an update on the situation on August 29, 2023, saying it expects that additional cases of MERS will be reported from countries where MERS-CoV is circulating in dromedary camels and that cases may be exported to other countries.

What is Middle East Respiratory Syndrome?

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness caused by the MERS Coronavirus (MERS-CoV). MERS-CoV was first reported in Saudi Arabia in 2012 but has caused infections worldwide, including in the United States. To date, all reported cases have been linked to travel to or residence in countries in or near the Arabian Peninsula. The largest known outbreak of MERS outside the Arabian Peninsula occurred in the Republic of Korea in 2015 and was associated with a traveler returning from the Arabian Peninsula.

MERS in the United States

The risk for MERS-CoV infection in the United States is very low for the general public. Only two patients have tested positive for MERS-CoV, both in May 2014 after traveling from Saudi Arabia. The CDC and other public health partners are monitoring the MERS situation and have implemented measures to prevent the spread of the disease. Get the most up-to-date information about MERS in the U.S. (CDC, https://www.cdc.gov/coronavirus/mers/us.html, Accessed 9/7/2023).

How Does MERS-CoV Spread?

Dromedary camels are the primary host of MERS-CoV, and humans can be infected through direct or indirect contact. Like other coronaviruses, MERS-CoV is thought to spread through respiratory secretions from an infected individual. Human-to-human transmission can occur through close contact, as may be the case when caring for or living with an infected person. Learn more about how MERS-CoV spreads (CDC, https://www.cdc.gov/coronavirus/mers/about/transmission.html, Accessed 9/7/2023).

MERS Symptoms and Complications

Patients with confirmed infection with MERS-CoV typically exhibit symptoms of respiratory illness including fever, cough, and shortness of breath. Other symptoms may include chills, body aches, sore throat, headache, diarrhea, nausea or vomiting, and runny nose.

Severe disease may lead to complications such as pneumonia, acute respiratory distress syndrome, septic shock, and multi-organ failure. Approximately three to four out of every 10 reported cases of MERS are fatal. Learn more about the symptoms and complications of MERS-CoV infection (CDC, https://www.cdc.gov/coronavirus/mers/about/symptoms.html, Accessed 9/7/2023).

See the CDC’s guidance for health care professionals on evaluating patients for MERS-CoV infection (CDC, https://www.cdc.gov/coronavirus/mers/interim-guidance.html, Accessed 9/7/2023).

Treatment and Care for MERS

There is no vaccine or specific antiviral treatment recommended for MERS-CoV infection. Treatment is supportive and depends on the patient’s symptoms and condition. The World Health Organization has issued guidance for the clinical management of severe acute respiratory syndrome when MERS-CoV infection is suspected.

Preventing the Spread of MERS

Because MERS-CoV can be transmitted from human to human, infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care settings. Health care workers should follow an identify, isolate, and inform strategy, and adhere to recommended infection control measures (CDC, https://www.cdc.gov/coronavirus/mers/infection-prevention-control.html, Accessed 9/7/2023), including standard, contact, and airborne precautions, when managing patients with probable or confirmed MERS-CoV infection.

Additional Resources for Health Care Personnel

• Download a sample screening protocol for MERS-CoV: Step-by-step guide for how to screen patients for signs and symptoms of MERS-CoV infection and evaluate their epidemiological risk based on travel and exposure history.
• See the CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from PUIs for MERS-CoV (CDC, https://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html, Accessed 9/7/2023).    
• Contact the CDC for epidemiologic and laboratory consultation for MERS: Email eocreport@cdc.gov with any questions about suspected MERS patients or MERS-CoV testing or call the CDC Emergency Operations Center (EOC) at 770-488-7100.
• Guidance for safe ambulance transport of MERS patients can be adapted from the “Special Respiratory Precautions” section of the EMS Infectious Disease Playbook.