The Ministry of Health in Italy, through the European Union’s Early Warning and Response System, has notified WHO of two more laboratory-confirmed cases with Middle East respiratory syndrome coronavirus (MERS-CoV) in the country.

Both patients are close contacts of the recent laboratory-confirmed case of a 45-year-old man who had travelled to Jordan. The first patient is a two-year-old girl and the second is a 42-year-old woman. All three cases are in a stable condition.

The man had returned to Italy on 25 May 2013 with symptoms of cough and fatigue. His condition deteriorated and he was hospitalized on 28 May. A laboratory test was conducted by the influenza reference laboratory of Tuscany and confirmed by the national influenza centre at the Istituto Superiore di Sanità.

Globally, since September 2012, WHO has been informed of a total of 53 laboratory-confirmed cases of infection with MERS-CoV, including 30 deaths: 11 of these cases have been reported from countries in the WHO European Region and include 4 deaths.

MERS-CoV countries in the European Region, cases and deaths (based on reporting country)

Reporting country Lab-confirmed cases Deaths France 2 (One treated in France after travelling from United Arab Emirates; one treated after locally acquired infection) 1 (Died in France after travelling from United Arab Emirates) Germany 2 (Both treated in Germany, one travelling from Qatar and the other travelling from United Arab Emirates) 1 (Died in Germany after travelling from United Arab Emirates) Italy 3 (One treated in Italy after travelling from Jordan; two treated after locally acquired infection) 0 United Kingdom 4 (One treated in United Kingdom after travelling from Qatar; one treated in United Kingdom after travelling from Saudi Arabia; two treated after locally acquired infection) 2 (One died in United Kingdom after travelling from Saudi Arabia; one died after locally acquired infection) TOTAL as of 01-06-2013 (pm) 11 4

WHO/Europe is coordinating the response to MERS-CoV with the European Union and the European Centre for Disease Prevention and Control. The Regional Office is also facilitating information exchange and coordination among countries in the European Region and the Eastern Mediterranean Region.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections and to review carefully any unusual patterns.

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.