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Health Intelligence Bulletin




  • World Health Organization (WHO)
  • Centers for Disease Control and Prevention (CDC)
  • European Centre for Disease Prevention and Control (ECDC)
  • National Environmental Agency, Singapore





The focus of attention regarding the MERS-CoV outbreak has shifted back to the Middle East region, where cases have been occurring since September 2012. The epidemic that occurred last summer in South Korea is now over. The Saudi authorities notified the WHO of 13 additional cases between September 12th and 18th.


Many of the cases are nosocomial, meaning they have been acquired from other patients in hospitals, including by health care workers. Several others involve patients who have had contacts with camels. As of September 27th 2015 the WHO reported a grand total of 1 583 cases and 566 deaths from MERS globally.




Essentially the key messages are that the chances of contracting the disease through community exposition are almost zero and Europ Assistance does not recommend any MERS related travel restrictions to the Middle East or Saudi Arabia.


Europ Assistance does however recommend avoiding unnecessary hospital visits at this stage in Saudi Arabia. People with chronic diseases should be particularly careful and in addition to avoid contacts with cases and institutions where cases are treated should avoid contact with animals and farms, and particularly with camels.


Clients operating clinics or employee healthcare facilities in those areas must have detection protocols in place, triage out people with fever and cough, and have ample personal protection equipment (PPE) for their staff.




The disease is essentially transmitted by droplets (tiny drops of body fluid, usually mucous or saliva, suspended in the air, usually via coughing or sneezing) from infected patients, and can also be transmitted by contact with camel or camel meat, milk or urine.

The great majority of cases are patients or healthcare workers that have been in contact with existing cases and therefore the main precautions must be to:


  • Still avoid visiting affected patients or their contacts, or healthcare facilities that are treating affected patients.


  • Protect oneself from droplet exposure when people are coughing by contact avoidance, by washing hands frequently and thoroughly with soap and water (use hand sanitizer if water and soap are unavailable) and respecting cough etiquette. Wearing masks when people around you are coughing adds extra protection.


  • Avoid contact with camel or camel meat, milk or urine.


  • Seek medical attention immediately if cough or fever occur, always mentioning any travel near a cluster of cases or any contact with a potential case.




The main symptoms to worry about are cough and fever associated to potential contact with MERS-CoV cases or visits to hospitals where such cases are being treated. Shortness of breath is a potential associated feature as is diarrhea. There are no vaccines available and no specific treatment exists. The main treatment is supportive.


In the last few weeks extensive fires, mainly in Indonesian forests have created a sometimes thick haze in major population concentrations and travel destinations in the area, particularly in Singapore. This creates respiratory difficulties for healthy people, and can cause a health risk for children, the elderly and people with respiratory diseases.


In general people should attentively pay attention to daily broadcasts concerning the level of exposure, and minimize outdoor activities especially when they belong to at risk categories. Only people with known significant respiratory disease should postpone their travel plans.


The WHO has warned that the capacity of the health care system in the country is seriously diminished and this renders access to proper care for even routine conditions difficult. Evacuation of acute cases by air ambulance to neighboring countries or to the nearest center of medical excellence is rendered almost impossible due to restrictions on flight authorizations. EA strongly recommend to all travelers without a critical need to travel to the country to abstain from doing so. As far as dengue is concerned, all precautions should be focused on the avoidance of mosquito bites. Spraying, mosquito nets and the avoidance of water accumulations is critical as no treatment exists. If serious symptoms develop, hospital consultation should be sought for supportive measures and management of hemorrhagic complications.


While public attention has decreased dramatically regarding this scourge that devastated three West African countries in 2014 and early 2015, it is still too early to reduce precautions. However the figures are more and more encouraging. During the week to September 20th, only two cases, both from Guinea were reported. The weekly incidence has been remained below 10 cases for two months. The latest cases have all been from the same regions straddling the border between western Guinea and Sierra Leone, making it a more localized outbreak.


Overall since the beginning of the epidemic there have been a total of 28 295 cases reported from the three countries with high transmission, and 11 295 reported deaths. The people aged 15 to 44 of both sexes are much more likely to be affected than children or older adults. Since the beginning of the outbreak there have been a total of 881 cases among health care workers, and 513 of those have passed away.


The most important piece of news in the recent weeks regarding the fight against Ebola virus disease (EVD) was the publication the “The Lancet” on July 31st of the interim analysis of the Guinea Phase III efficacy vaccine trial which show that VSV-EBOV, a vaccine produced by the MSD Company, is highly effective. This was hailed as a very promising development by Dr. Margaret Chan, the Director General of the World Health Organization (WHO).


Europ Assistance does not recommend any travel restrictions anymore, but travelers are advised to stay away from institutions where Ebola cases are treated, to avoid attending funerals of Ebola victims, and to avoid contact with bush meat.


The WHO also issued in September 2015 interim guidelines for Ebola virus disease in pregnancy. To provide guidance infection prevention and control during childbirth, the management of pregnant EVD cases and lactation, although there is no evidence that women who survive EVD and then become pregnant pose a risk for virus transmission.