1. MERS-CoV: the global epidemiology
Republic of Lebanon
Ministry of Public Health
Epidemiological Surveillance Program
May 2014

2. Sources WHO: www.who.int CDC: www.cdc.gov ECDC: www.ecdc.europa.eu
 world map:

3. Outline
Total count
By time
By place
By person
Travel advice

4. Total count Since April 2012 to 08 May 2014
536 laboratory-confirmed cases of MERS-CoV
including 145 deaths
To date, the affected countries
Middle East; Jordan, Kuwait, Oman, Qatar, Saudi Arabia (KSA), United Arab Emirates (UAE) and Yemen
Africa: Egypt and Tunisia
Europe: France, Germany, Greece, Italy and the United Kingdom
Asia: Malaysia and Philippines
North America: the United States of America (USA).
All of the cases recently reported outside the Middle East recently travelled from countries inside of the Middle East (KSA or UAE).
Source: WHO

5. Confirmed cases by country of presumed exposure
Time: Epidemic Curves
Confirmed cases by country of presumed exposure
Source: WHO

6. Time: Epidemic Curves
Confirmed cases by outcome
Source: WHO

7. Epidemic Curve by Case-Type (Primary vs. Secondary)
Time: Epidemic Curves
Epidemic Curve by Case-Type (Primary vs. Secondary)
Source: WHO

8. Place: of onset (up to 16May 2014)
Source: ECDC

9. Place: of onset (up to 16May 2014)
Source: ECDC

10. Cases by country of probable exposure
Place: place of exposure
Cases by country of probable exposure
Source: WHO

11. Place: place of exposure
Source: WHO

12. Place: place of exposure
Source: ECDC

13. Source: http://coronamap.com
Place: World map
Source:

14. Person Gender: 66% of cases are male
Median age is 49 years old (range 9 months-94 years old)
Primary < secondary cases

15. Person
Source: ECDC

16. Characteristics of primary vs secondary cases*
Person
Characteristics of primary vs secondary cases*
*Table includes cases with reported information on each variable; 234 cases have missing information about case type
Characteristic
Primary Cases
Secondary Cases n 98
204
Median age in years (range)
57.5 (2-90)
39 (9m-94)
% of male cases
80% (78/97)
56% (111/198)
% of cases with ≥1 underlying condition reported
84% (74/88)
69% (66/96)
% of cases classified as fatal
83% (48/58)
45% (33/74)
% Severe
91% (88/97)
27% (53/198)
% Asymptomatic
42% (84/198)
% Health care workers
5% (2/41)
63% (93/147)
% reported contact with camels
33% (23/70)
9% (3/32)
Source: WHO

17. WHO Travel Advice 1
At this time, the risk to an individual pilgrim of contracting MERS-CoV is considered very low.
WHO does not recommend the application of any travel or trade restrictions or entry screening.
Before departure, pilgrims should be advised:
Pre-existing major medical conditions can increase the likelihood of illness, including MERS-CoV infection, during travel
Pilgrims should consult a health care provider to review the risk and assess whether making the pilgrimage is advisable

18. WHO Travel Advice 2
Dissemination of general travel health precautions, which will lower the risk of infection in general.
Specific emphasis should be placed on:
Washing hands often with soap and water , or with hand rub
Adhering to good food-safety practices (avoiding undercooked meat or food prepared under unsanitary conditions, and properly washing fruits and vegetables before eating them)
Maintaining good personal hygiene
Avoiding unnecessary contact with farm, domestic, and wild animals

19. WHO Travel Advice 3
Travelers who develop a significant ARI with fever and cough (severe enough to interfere with usual daily activities) should be advised to:
Minimize their contact with others
Adopt cough etiquette: Cover their mouth and nose with a tissue when coughing or sneezing and discard the tissue in the trash after use and wash hands afterwards, or, if this is not possible, to cough or sneeze into upper sleeves of their clothing, but not their hands
Report to the medical staff

20. WHO Travel Advice 4 Patients: Clinicians:
Returning pilgrims developing a significant ARI with fever and cough during the two weeks after their return should seek medical attention.
Persons who have had close contact with a pilgrim or traveler with a significant ARI with fever and cough and who themselves develop such an illness should seek medical attention.
Clinicians:
Practitioners and facilities should be alerted to the possibility of MERS-CoV infection in returning pilgrims with ARI, especially those with fever and cough and pulmonary parenchymal disease
If clinical presentation suggests the diagnosis of MERS-CoV, laboratory testing, should be done and infection prevention and control measures implemented.