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ARCHIVE LATEST MERS-CoV situation update

23 January 2019, 17:00 hours; Rome


Information provided herein is current as of the date of issue. Information added or changed since the last MERS-CoV situation update appears in red. Human cases are depicted in the geographic location of their report. For some cases, exposure may have occurred in one geographic location but reported in another. For cases with unknown onset date, reporting date was used instead. FAO compiles information drawn from multiple national (Ministries of Agriculture or Livestock, Ministries of Health; Centers for Disease Prevention and Control [CDC]) and international sources (World Health Organization [WHO], World Organisation for Animal Health [OIE]) as well as peer-reviewed scientific articles. FAO makes every effort to ensure, but does not guarantee, accuracy, completeness or authenticity of the information. The designation employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers.



Situation: Middle East Respiratory Syndrome Coronavirus (MERS-CoV): zoonotic virus with pandemic potential.
Countries with known human cases1: Jordan, Saudi Arabia (KSA), Qatar, the United Arab Emirates (UAE), Oman, Kuwait, Yemen, United Kingdom, France, Germany, Italy, Tunisia, Malaysia, the Philippines, the United States of America (USA), Egypt, Lebanon, the Netherlands, Iran, Algeria, Turkey, Austria, Greece, Republic of Korea, China, Thailand, the Kingdom of Bahrain.
Findings in humans: 2,286 cases confirmed; including 843 case fatalities (since September 2012)2.
Countries with published animal findings (serology and/or virology): Bangladesh, Burkina Faso, Chile, Egypt, Ethiopia, Iran, Iraq, Israel, Jordan, Kenya, Kuwait, Mali, Morocco, Nigeria, Oman, Pakistan, Qatar, Saudi Arabia (KSA), Somalia, Spain (Canary Islands), Sudan, Tunisia, United Arab Emirates.


1 Countries in order of first reported occurrence
2 For detailed information on human cases, please refer to WHO at


 Situation in animals

Map 1. MERS-CoV livestock field surveys by country*

Map of MERS-CoV livestock field surveys by country
Click to enlarge - *Note: Positive findings in Spain refer to samples taken in the Canary Islands. Livestock surveillance in Chile, not pictured, resulted negative.


 Situation in humans

  • Between 19 December 2018 and 23 January 2019, Nine (n=9) new human cases have been reported in Saudi Arabia, with one (n=1) fatality.

Map 2. For a global distribution of human MERS-CoV cases please see our map [here]


Table 1. MERS-CoV cases in humans by country and dates of first and most recent observations




Cumulative number of confirmed MERS-CoV human cases

First observation

Last Observation

Middle East Saudi Arabia 1,909 13/06/2012 22/01/2019
United Arab Emirates 88 19/03/2013 04/05/2018
Jordan 26 02/04/2012 26/09/2015
Qatar 19 15/08/2013 14/05/2017
Oman 11 26/10/2013 23/02/2018
Iran (Islamic Republic of) 6 11/05/2014 18/03/2015
Kuwait 4 30/10/2013 08/09/2015
Lebanon 2 22/04/2014 08/06/2017
Yemen 1 17/03/2014 17/03/2014
Bahrain (the Kingdom of) 1 04/04/2016 04/04/2016
Europe United Kingdom 5 03/09/2012 16/08/2018
Germany 2 05/10/2012 07/03/2015
Netherlands 2 01/05/2014 05/05/2014
France 2 23/04/2013 27/04/2013
Austria 2 22/09/2014 08/09/2016
Turkey 1 25/09/2014 25/09/2014
Italy 1 25/05/2013 25/05/2013
Greece 1 08/04/2014 08/04/2014
Asia Republic of Korea 186 11/05/2015 28/08/2018
Philippines 3 15/04/2014 30/06/2015
Thailand 3 10/06/2015 25/07/2016
China 1 21/05/2015 21/05/2015
Malaysia 2 08/04/2014 24/12/2017
Americas United States of America 2 14/04/2014 01/05/2014
Africa Tunisia 3 01/05/2013 17/06/2013
Algeria 2 23/05/2014 23/05/2014
Egypt 1 22/04/2014 22/04/2014

Figure 1. Human epidemiological timeline (with cases reporting animal exposure in blue), by month of disease onset (since January 2015)
Human epidemiological timeline (with cases reporting animal exposure in blue), by month of disease   onset (since January 2015)

Click to enlarge

Figure 2. Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Breakdown of human MERS-CoV cases by potential source of exposure (in percent)
Click to enlarge - Note: Please note that while infection control improves in healthcare settings and history of animal contact is recorded more consistently in case investigations, the overall number of cases has decreased (see figure 1). The apparent increase in proportion of primary cases with animal exposure therefore should be interpreted in the overall context of a reduced human case count. Data not displayed prior to July 2015 as a result of inconsistent collection of human epidemiological data before this date.


 Recent publications

  • Banerjee A, Kulcsar K, Misra V, Frieman M, Mossman K. Bats and Coronaviruses. Viruses. 2019 Jan 9;11(1). pii: E41. [reference] In this article the authors reviewed studies on CoV outbreaks that are speculated to have originated in bats and also those studies that have allowed researchers to identify unique adaptation in bats that may allow them to harbor CoVs without severe disease. They offer suggestions on future studies that are critical to identify how bats can harbor multiple strains of CoVs and factors that enable these viruses to "jump" from bats to other mammals in order to address key research gaps.
  • Farag E, Sikkema RS, Vinks T, Islam MM, Nour M, Al-Romaihi H, Al Thani M, Atta M, Alhajri FH, Al-Marri S, AlHajri M, Reusken C, Koopmans M. Drivers of MERS-CoV Emergence in Qatar. Viruses. 2018 Dec 31;11(1). pii: E22. [reference] This study sought to identify and quantify possible drivers for the MERS-CoV emergence and spillover to humans. A list of potential human, animal and environmental drivers for disease emergence were identified from literature. Trends in possible drivers were analyzed from national and international databases, and through structured interviews with experts in Qatar. Lifestyle changes, the flourishing of camel husbandry and competitions, and the rapidly occurring desertification that forced banning of free grazing in 2005 were all considered factors. The authors conclude that the transition in husbandry leading to high density camel farming along with increased exposure to humans, combined with the increase of camel movement for the racing and breeding industry, have led to a convergence of factors driving spillover of MERS-CoV from camels to humans.
  • Ommeh S, Zhang W, Zohaib A, Chen J, Zhang H, Hu B, Ge XY, Yang XL, Masika M, Obanda V, Luo Y, Li S, Waruhiu C, Li B, Zhu Y, Ouma D, Odendo V, Wang LF, Anderson DE, Lichoti J, Mungube E, Gakuya F, Zhou P, Ngeiywa KJ, Yan B, Agwanda B, Shi ZL. Genetic Evidence of Middle East Respiratory Syndrome Coronavirus (MERS-Cov) and Widespread Seroprevalence among Camels in Kenya. Virol Sin. 2018 Dec;33(6):484-492. [reference] This study describes the first genome isolation of Middle East respiratory syndrome coronavirus in Kenya. Previous studies of MERS-CoV in Kenya mainly focused on site-specific and archived camel and human serum samples for antibodies. Study authors conducted active nationwide cross-sectional surveillance of camels and humans in Kenya, targeting both nasal swabs and plasma samples from 1,163 camels and 486 humans collected from January 2016 to June 2018. A total of 792 camel plasma samples were positive by ELISA. Seroprevalence increased with age, and the highest prevalence was observed in adult camels (82.37%, 95% confidence interval (CI) 79.50-84.91). More female camels were significantly seropositive (74.28%, 95% CI 71.14-77.19) than male camels (P < 0.001) (53.74%, 95% CI 48.48-58.90). Only 11 camel nasal swabs were positive for MERS-CoV by reverse transcription-quantitative PCR. Phylogenetic analysis of whole genome sequences showed that Kenyan MERS-CoV clustered within sub-clade C2, which is associated with the African clade, but did not contain signature deletions of orf4b in African viruses.
  • Bak SL, Jun KI, Jung J, Kim JH, Kang CK, Park WB, Kim NJ, Oh MD. An Atypical Case of Middle East Respiratory Syndrome in a Returning Traveler to Korea from Kuwait, 2018. J Korean Med Sci. 2018 Dec 20;33(53):e348. doi: 10.3346/jkms.2018.33.e348. eCollection 2018 Dec 31. [reference] This study reports on a MERS-CoV infection in a 61-year-old businessman returning from Kuwait. The patient arrived there on August 16, 2018, developed watery diarrhea on August 28 (day 0), and came back to Korea on September 7 (day 10) as his condition worsened. Upon arrival, he complained of diarrhea and weakness, but denied any respiratory symptoms, and he directly went to visit an emergency room. Chest radiography revealed interstitial infiltrates in the lungs, and he was immediately transferred to an isolation unit. Quantitative real-time PCR analysis of sputum samples taken on day 11 returned positive for MERS-CoV. No secondary MERS-CoV infection was identified among people who had close contact with him. This case underscores the importance of a high index of suspicion of MERS-CoV infection in any febrile patients who present after a trip to the Middle East.
  • Mirkena, T., Walelign, E., Tewolde, N. et al. Camel production systems in Ethiopia: a review of literature with notes on MERS-CoV risk factors. Pastoralism. 2018, 8: 30. [reference] In this paper authors outline the camel production systems in Ethiopia (including herd sizes, housing, sex, and use) while identifying potential risk factors for MERS-CoV transmission present in each.
  • Hwang SM, Na BJ, Jung YM, Lim HS, Seo JE, Park SN, Cho YS, Song EH, Seo JY, Kim SR, Lee GY, Kim SJ, Park YS, Seo HS. Clinical and Laboratory Findings of MERS-CoV infection. Jpn J Infect Dis. 2018 Dec 25. [reference] This hospital-based retrospective study compared MERS-CoV-positive patients with MERS-CoV-negative patients in the Republic of Korea. A total of 7 positive patients and 55 negative patients with a median age of 43 (P = 0.833) were included. No statistical differences were observed in relation to sex and the presence of comorbidities. At the time of admission, headache (28.6% vs 3.6%; OR, 10.60; 95% CI, 1.22-92.27), myalgia (57.1% vs. 9.1%; OR, 13.33; 95% CI, 2.30-77.24), and diarrhea (57.1% vs 14.5%; OR, 7.83; 95% CI, 1.47-41.79) were common among MERS-CoV-positive patients. MERS-CoV patients were more likely to have a low platelet count (164±76.57 vs 240±76.57) and eosinophil (0.27±0.43 vs. 2.13±2.01; p-value<0.001). Chest radiography with diffuse bronchopneumonia was more frequent in MERS-CoV-positive patients than in negative patients (100% vs 62.5%; p-value=0.491). Also, chest X-ray revealed that diffuse bronchopneumonia might enhance the ability to detect which patients were infected with MERS-CoV in South Korea.
  • Kandeil A, Gomaa M, Shehata M, El-Taweel A, Kayed A, Abiadh A, Jrijer J, Moatasim Y, Kutkat O, Bagato O, Mahmoud S, Mostafa A, El-Shesheny R, Perera R, Ko R, Hassan N, Elsokary B, Allal L, Saad A, Sobhy H, McKenzie P, Webby R, Peiris M, Ali M, and Kayali G. Middle East respiratory syndrome coronavirus infection in non-camelid domestic mammals. [reference]


  • The meeting report from the FAO-OIE-WHO tripartite meeting held in Geneva, 25-27 September 2017 has been published in Antiviral Research [reference].
  • A poster entitled ‘MERS-CoV in Animals: a Scoping Review’ has been accepted for the 5th International One Health Congress in Saskatoon, Canada from 22-25 June 2018.
  • A poster entitled ‘Harmonization and flexibility in a multi-country project - FAO MERS-CoV surveillance in camels’ has been accepted for the Prince Mahidol Award Conference (PMAC) held in Bangkok, Thailand from 29 January to 3 February 2018.
  • A FAO-OIE-WHO tripartite meeting was held in Geneva, 25-27 September 2017 [reference]. Representatives from Ministries of Health and Ministries of Agriculture in affected and at risk countries, MERS-CoV subject-matter experts and researchers, funders, industrial partners and representatives from FAO, OIE and WHO attended. The specific objectives of this meeting were to (i) summarize and communicate research progress made, with a focus on new research and knowledge gained; (ii) improve coordination and communication between animal health and public health sectors in outbreak preparedness and response, active surveillance and technical issues of disease control and prevention, and (iii) to review and update previous recommendations based on latest scientific evidence. [#tackleMERS]
  • In close collaboration with OIE and WHO, monitoring the situation / inter-agency teleconferences;
  • Analysing available data, including results from surveillance in camels and advanced characterization of the virus;
  • Providing technical assistance and guidance to countries to improve understanding of the disease situation and help filling existing gaps in epidemiological knowledge;
  • Supporting national laboratories to develop capacity in serology and PCR diagnostic for MERS-CoV, quality assurance and quality control and biosafety, and establish national sample banks;
  • Keeping a dialogue between the scientific community and the field to ensure needs and gaps are addressed;
  • Assist in developing communication strategies to ensure appropriate information reaches the public on MERS-CoV and avoid possible negative impacts of the crisis on the livestock industry.

Country-level actions


  • On 28 January 2019, Egypt will complete the 2018 longitudinal and repeated cross sectional studies, jointly implemented by General Organization for Veterinary Service (GOVS) and Animal Health Research Institute (AHRI).
  • On 12 November, the third and last phase of quarantine sampling started and will run until end of January 2019 with sampling intervals of 14 days. In seven rounds, 350 camel sera and 350 nasal swabs were collected from Abo-Simble Quarantine Station (Aswan Governorate).
  • Testing of all collected samples is ongoing at AHRI, both serology and RT-PCR.


  • Field testing of the ”General Population Study” questionnaires, to be jointly implemented with WHO, will be conducted in collaboration with the NAHDIC from 28 January to 7 February 2019. A concept note has been prepared and field mission preparation is underway.
  • An article on camel production systems in Ethiopia: a review of literature with notes on MERS-CoV risk factors has been published on Pastoralism: Research, Policy and Practice (link).
  •  A national consultation of MERS-CoV stakeholders was held from 9-10 January 2019. Participants discussed the 2020-2021 MERS-CoV work plan, surveillance results in the epizone, and study design for 2019. The following important recommendations were put forward: (i) Inclusion of camel tissue (nasal turbinate, lymph nodes) and nasal swab sampling from abattoirs; (ii) sampling procedures and the use of flocked rather than tipped swabs, and; (iii) the inclusion of additional national partners in the study, which was discussed and agreed.


  • The 2018 longitudinal study follow-up report inclusive of laboratory test results, both serological and RT-PCR, has been finalized.


  • Three rounds of camel sampling for the longitudinal surveillance were completed in two locations (Azraq, Ramtha); all 12 camels sampled in Rmtha region (North of Joran) were found positive for MERS-CoV using RT-PCR.
  • The 12 positive samples have been sequenced through  Jordan University of Science and Technology (JUST) at Macrogene lab - Korea, and results showed that all viruses belonged to Clade B.
  • A Letter of Agreement (LoA) was signed with Faculty of Veterinary Medicine - JUST in December 2018 to conduct field testing of the questionnaires for the "General Population Study", to be jointly implemented with WHO.


Press Releases


 Important links