On September 3, 2018, the World Health Organization (WHO) reported a single confirmed case of Middle East Respiratory Syndrome coronavirus (MERS Co-V or MERS) in a male resident who had recently traveled to Saudi Arabia (1). He sought medical care at a hospital in Leeds, where he was put into isolation and was transferred to the care of infectious disease specialists in Liverpool (1). This is the fifth case of MERS in the UK, after four cases occurred in 2012 and 2013 (1).
Following this report comes a confirmed case of MERS in a South Korean man, marking the first case of MERS in South Korea since July 2015 (2). He was reportedly in Saudi Arabia from August 16 to September 6, 2018 and was hospitalized immediately after his return and was a confirmed case of MERS by September 8, 2018 (3). A total of 20 contacts, including flight crews and medical staff have been placed under isolation in their homes until it can be confirmed whether they have contracted MERS from the patient (3).
Clinical presentation of MERS includes fever, cough, shortness of breath, acute upper respiratory illness and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure (4, 5). Some cases of MERS have gastrointestinal symptoms, including nausea and diarrhea (4). Approximately 30-40% of MERS cases result in death, though most deaths also had underlying medical issues (4). There is no specific treatment for MERS, rather treatment focuses on alleviating symptoms, so it is critical to seek medical care if any symptoms occur (6).
With the world continually becoming more accessible through travel, public health officials need to be ready for anything. Important events, which result in mass gatherings, bring people from around the globe to a single location for a period of time and can be a potential risk for disease spread. Of note, the Hajj just took place in August in Mecca, Saudi Arabia and may be involved with the current MERS cases (7). Every year, the Hajj attracts two to three million people each year in the holy Muslim city. This mass increase to a singular location poses unique health risks as untreated infectious diseases can spread from one person to another as people are in close contact with one another. Once people leave, there becomes the potential for a multi-location outbreak as those journeying to the Hajj come from locations around the globe. The incubation period for MERS is 2 to 14 days, which means a person has ample opportunity to potentially expose great numbers of people to the disease before exhibiting symptoms of disease themselves (5).
The WHO reports that most cases of human-to-human transmission occur when people are in close contact with an infected person for a sustained period of time, but there is low risk of transmission if adequate prevention and control protocols are taken (1). It is expected that there will be sporadic cases reported throughout the Middle East and in other countries, as early symptoms of MERS are non-specific (1).