First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities - May 2014

Abstract

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.

FIGURE 1

Number of confirmed cases of Middle East respiratory syndrome coronavirus infection (145 fatal and 391 nonfatal) reported by the World Health Organization (WHO) as of May 12, 2014, by month of illness onset — worldwide, 2012–2014 * Case count for May assumes that three cases included in WHO announcements on May 22, 23, and June 2, 2013, had symptom onset during May 2013. ^† Case count for June assumes that 22 cases included in WHO announcements on June 14, 17, 22, 23, 26, and July 5, 7, 11, 2013, had symptom onset during June 2013. ^§ Case count for July assumes that 10 cases included in WHO announcements on July 18, July 21, and August 1, 2013 had symptom onset during July 2013. ^¶ Case count for August assumes that 25 cases included in WHO announcements (six cases on August 28, one case August 29, two cases August 30, and 16 cases September 16) had symptom onset during August 2013. ** Case count for September assumes that four cases included in WHO on October 4 and 24 announcements had symptom onset during September 2013. ^†† Assumes that three cases had symptom onset during November 2013. ^§§ Assumes that six cases had symptom onset during December 2013. ^¶¶ Assumes that two cases had symptom onset during February 2014. *** Assumes that 16 cases had symptom onset during March 2014. ^††† Assumes that 66 cases had symptom onset during April 2014.

FIGURE 2

Confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection (N = 536) (and deaths) reported by the World Health Organization as of May 12, 2014, and history of travel from in or near the Arabian Peninsula within 14 days of illness onset — worldwide, 2012–2014 Source: Adapted from Epidemiological update: Middle East respiratory syndrome coronavirus. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2014. Available at http://www.ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?List=8db7286c-fe2d-476c-9133-18ff4cb1b568&ID=998.

FIGURE 3

Points of entry and volume of travelers on flights to the United States and Canada from Saudi Arabia and the United Arab Emirates — May–June 2014* Source: BioMosaic, an analytic tool for integrating demography, migration, and health data developed in collaboration between the University of Toronto, Boston Children’s Hospital, and CDC’s Division of Global Migration and Quarantine. * Excludes cities with fewer than 100 travelers from affected areas. ^† Based on total number of arrivals at final destination in North America.