Middle East respiratory syndrome coronavirus (MERS-CoV) – Bahrain

On 10 April 2016, the National IHR Focal Point of Bahrain notified WHO of a fatal case of Middle East respiratory syndrome coronavirus (MERS-CoV). This is the first case reported in Bahrain.

Details of the case

A 61-year-old, Saudi male was admitted on 29 March to a health care facility in Bahrain for an unrelated medical condition. He was screened for MERS-CoV, a routine procedure for those coming from Saudi Arabia, and tested negative for the infection. On 4 April, and while hospitalized, he developed symptoms. On 9 April, the patient tested positive for MERS-CoV. The patient had comorbidities. He owned a dromedary barn in Saudi Arabia and had a history of frequent contact with them and consumption of their raw milk. He had no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms. On 12 April, he was transferred to a hospital in Dammam city, Saudi Arabia but passed away on the same day.

The National IHR Focal Point for the Kingdom of Saudi Arabia has been notified. Contact tracing of household and healthcare contacts is ongoing for this case. The Ministry of Agriculture was notified and investigation of dromedaries is also ongoing.

Globally, since September 2012, WHO has been notified of 1,725 laboratory-confirmed cases of infection with MERS-CoV, including at least 624 related deaths.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

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

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.