General information for health professionals, laboratories and hospitals on MERS coronavirus

This page contains general information for health professional, laboratories and hospitals.

Page last updated: 08 July 2019

Information on how to manage a suspected MERS case in a hospital setting can be found on the Department of Health website here.

Information on how to manage a suspected MERS case in a general practice setting can be found on the Department of Health website here.

Countries with laboratory-confirmed MERS cases

What’s new in this advice?

Cases and clusters continue to be reported from the Middle East, particularly Saudi Arabia.

Rare cases continue to be diagnosed outside of the Middle East in people who are exposed in the Middle East.

The Australian Government Department of Health strongly recommends international travellers be immunised for influenza and measles. Refer to the Australian Immunisation Handbook for more information.

Key point

Health professionals should be alert to the possibility of MERS in unwell travellers returning from the Middle East, and obtain a full travel and exposure history. Apply appropriate infection control measures as soon as MERS is suspected and contact your local Public Health Unit immediately.

Summary

  • As of the 30 April 2019, the World Health Organization (WHO) global case count for MERS was 2,432 laboratory-confirmed cases since the first cases were reported in September 2012. There have been 840 deaths (case fatality rate 35%). The latest situation updates can be found on the World Health Organization website.
  • All cases have been linked with travel to or residence in the Middle Eastern countries. A list of these affected countries can be found here.
  • MERS Coronavirus is a zoonotic virus that has repeatedly entered the human population via infected dromedary camels in the Middle East. Person-to-person transmission is known to occur, particularly in healthcare settings, and particular attention to infection control is required.
  • Sporadic infections have typically presented with, or later developed, severe acute lower respiratory disease. This has predominantly occurred in adult males with underlying medical conditions.
  • Mild or asymptomatic secondary infections have occurred in people of all ages. These are usually people who have been tested because they were close contacts of a seriously ill case either in healthcare or household settings.
  • There is no evidence of ongoing community transmission in any country and only occasional instances of household transmission, including in an outbreak in Saudi Arabia in early 2019. Transmission in health care settings has been a feature of the outbreak.
  • People with underlying illnesses (such as diabetes, renal failure, chronic lung disease, and the immunocompromised) are considered at high risk of severe disease from MERS and should consult their health care provider before travelling to discuss the risks. This group of people should avoid contact with dromedary camels.
  • All people travelling to the Middle East should take general precautions when visiting farms and markets where camels might be present and avoid the consumption of raw or undercooked camel products, such as meat, urine and milk. Travellers should wash their hands often, including before eating, and after touching animals and adhere to food safety and hygiene measures. Close contact with people or animals that are unwell should be avoided.
  • Anyone travelling to the Middle East to work or volunteer in a healthcare setting should seek advice and ensure they are fully informed about infection control procedures and recommendations.

What is MERS coronavirus and how does it spread?

MERS coronavirus is a zoonotic virus that has repeatedly entered the human population via direct or indirect contact with infected dromedary camels in the Arabian Peninsula, although the mechanism of spread is unclear. MERS coronavirus is genetically distinct from the SARS coronavirus, and appears to behave differently. Coronaviruses are a large and diverse family of viruses that include viruses that are known to cause illness in humans (including the common cold), and in animals.

Scientific evidence suggests that MERS coronavirus is not present in Australian camels.

Many confirmed cases have occurred in healthcare-associated clusters, and there have been a large number of cases in healthcare workers, mainly in hospital settings. Secondary infections have most frequently been associated with healthcare settings, but have also occurred amongst family and workplace contacts.

The virus does not seem to transmit easily, unless there is close contact, such as occurs when providing unprotected care to a patient. The particular conditions or procedures that lead to transmission in hospital are not well known. From observational studies, transmission in health-care settings is believed to have occurred before adequate infection prevention and control procedures were applied and cases were isolated. A joint mission to the Republic of Korea (where in 2015, the only large outbreak outside of the Middle East occurred) assessed that factors contributing to the outbreak were a lack of awareness about MERS, sub-optimal infection control, overcrowding in emergency departments, multi-bed rooms, the practice of doctor-shopping or seeking care at multiple hospitals and the practice of having many visitors including family members staying in the room as carers.

MERS has so far not been demonstrated to transmit from asymptomatic cases to their contacts.

Health professionals are encouraged to follow the recommended infection prevention measures as soon as MERS is suspected so as to minimise the risk of transmission.

Symptoms

Sporadic infections have typically presented with, or later developed, severe acute lower respiratory disease, with radiological, clinical or histopathological evidence of pneumonia and pneumonitis. Typical symptoms have included fever, cough, shortness of breath, and breathing difficulties. Sporadic cases have predominantly been adult males with underlying medical conditions that may have predisposed them to infection, or may have increased the severity of the disease, including diabetes, kidney disease, hypertension, asthma and lung diseases, cancer and cardiovascular disease. Health professionals should be aware of the possibility of atypical presentations including fever, diarrhoea, muscle pain, nausea and vomiting.

Secondary infections acquired through person-to-person spread have occurred in people of all ages, may frequently have mild influenza-like symptoms or be asymptomatic.

Approximately 35% of patients with MERS have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems. Until more is known about the disease, the case fatality rates are counted only amongst the laboratory-confirmed cases.

Pre-travel advice, travel restrictions, periods of peak travel

The WHO does not currently recommend any restrictions to travel due to the MERS outbreak.

Umrah and Hajj including vaccination recommendations

Health professionals should be aware that many Muslims from Australia travel to Saudi Arabia to undertake the Umrah throughout the year but particularly during the period at the end of Ramadan in early May/June and for the Hajj, currently around August.

The Saudi Arabian Ministry of Health has specific vaccination requirements for Umrah and Hajj pilgrims, which can be found in the "Health Requirements and Recommendations for Travellers to Saudi Arabia for Hajj and Umrah" on the WHO website. In addition to these requirements, the Australian Government Department of Health recommends all travellers have up to date vaccinations, including routine vaccinations (such as tetanus, diphtheria, pertussis, measles, mumps, rubella, influenza and polio vaccinations), and vaccines required for occupational risk, lifestyle risks or underlying medical conditions.

There is no vaccine available for MERS.

Pre-travel advice

All people travelling to the Middle East should take general precautions when visiting farms and markets where camels might be present. Travellers should wash their hands often, including before eating, and after touching animals and adhere to food safety and hygiene measures. Hand sanitiser may be used when soap and water is not available. Close contact with people or animals that are unwell should be avoided. In addition to the usual food and water precautions, travellers should avoid consuming raw or unpasteurised camel products, including milk, urine and meat.

People with underlying illnesses (such as diabetes, renal failure, chronic lung disease, and the immunocompromised) are considered at high risk of severe disease from MERS and should consult their health care provider before travelling to discuss the risks. In addition to the advice for all travellers, this group of people should avoid contact with dromedary camels.

A factsheet and an information card on MERS are available for travellers on the Department of Health website here.

Anyone travelling to affected areas to work or volunteer in a healthcare setting should seek advice and ensure they are fully informed about infection control procedures and recommendations.

Who should be tested for MERS?

The likelihood of a case of pneumonia or pneumonitis in Australia being due to MERS is very low, and health professionals should investigate as usual, but be aware of the possibility of MERS in patients with a compatible exposure history.

Testing and initial infection control and public health actions for MERS should be undertaken for persons with:

  1. Fever AND pneumonia or pneumonitis or acute respiratory distress syndrome (ARDS) AND
    • history of travel from or residence in affected countries in the Middle East1 within 14 days before symptom onset, OR
    • contact2 (within the incubation period of 14 days) with a symptomatic traveller who developed fever and acute respiratory illness of unknown aetiology within 14 days after travelling from affected countries in the Middle East, OR
    • contact (within the incubation period of 14 days) with a symptomatic traveller who developed fever and acute respiratory illness of unknown aetiology within 14 days after travelling from a region with a known MERS outbreak at that time3

OR

  1. Fever AND symptoms of respiratory illness (e.g. cough, shortness of breath) AND
    • being in a healthcare facility (as a patient, worker, or visitor) in a country or territory in which recent healthcare-associated cases of MERS have been identified3 within 14 days before symptom onset, OR
    • being in contact with camels or raw camel products within affected countries in the Middle East within 14 days before symptom onset.

OR

  1. Fever OR acute symptoms compatible with MERS AND onset within 14 days after contact with a probable or confirmed MERS case while the case was ill.

OR

  1. Testing and initial infection control and public health actions for MERS should also be considered, in consultation with the public health unit, where there is a cluster of patients with severe acute respiratory illness of unknown aetiology following routine microbiological investigation, particularly where the cluster includes health care workers.

Further information

Information on how to manage a suspected MERS case in a hospital setting can be found on the Department of Health website here.

Information on how to manage a suspected MERS case in a general practice setting can be found on the Department of Health website here.

WHO situation updates and the latest advice is available from the WHO website

DFAT’s Smartraveller website information for travellers

United States Centers for Disease Control and Prevention MERS-CoV pages

European Centre for Disease Prevention and Control - MERS


  1. Affected countries in the Middle East include Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia (KSA), United Arab Emirates (UAE) and Yemen
  2. A close contact is defined as requiring greater than 15 minutes face-to-face contact with a symptomatic probable or confirmed case in any setting, or the sharing of a closed space with a symptomatic probable or confirmed case for a prolonged period (e.g. more than 2 hours).

    A casual contact is defined as any person having less than 15 minutes face-to-face contact with a symptomatic probable or confirmed case in any setting, or sharing a closed space with a symptomatic probable or confirmed case for less than 2 hours.

    For more details, and for examples of people in these categories, see section 11 of the CDNA Series of national guidelines for MERS (/internet/main/publishing.nsf/Content/cdna-song-mers-cov.htm) Definition of contact.

  3. Refer to the Department of health website for list of countries currently experiencing a MERS outbreak.

    Note: Transiting through an international airport (<24 hours stay, remaining within the airport) in the Middle East is not considered to be risk factor for infection.