CDC continues to work in consultation with the World Health Organization (WHO) and other partners to better understand the public health risk posed by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), formerly known as novel coronavirus, which was first reported to cause human infection in September 2012 (1–4). The continued reporting of new cases indicates that there is an ongoing risk for transmission to humans in the area of the Arabian Peninsula. New reports of cases outside the region raise concerns about importation to other geographic areas. Nosocomial outbreaks with transmission to health-care personnel highlight the importance of infection control procedures. Recent data suggest that mild respiratory illness might be part of the clinical spectrum of MERS-CoV infection, and presentations might not initially include respiratory symptoms. In addition, patients with comorbidities or immunosuppression might be at increased risk for infection, severe disease, or both. Importantly, the incubation period might be longer than previously estimated. Finally, lower respiratory tract specimens (e.g., sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate) should be collected in addition to nasopharyngeal sampling for evaluation of patients under investigation. An Emergency Use Authorization (EUA) was recently issued by the Food and Drug Administration (FDA) to allow for expanded availability of diagnostic testing in the United States.
As of June 7, 2013, a total of 55 laboratory-confirmed cases have been reported to WHO. Illness onsets have occurred during April 2012 through May 29, 2013 (Figure 1). All reported cases were directly or indirectly linked to one of four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates (Figure 2). Most cases (40) were reported by Saudi Arabia. Four countries, the United Kingdom (UK), Italy, France, and Tunisia, have reported cases in returning travelers and their close contacts (5–8). Ill patients from Qatar and the United Arab Emirates have been transferred to hospitals in the UK and Germany. To date, no cases have been reported in the United States. WHO and CDC have not issued any travel advisories at this time; updated information for travelers to the Arabian Peninsula is available at http://wwwnc.cdc.gov/travel/notices/watch/coronavirus-arabian-peninsula.
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