Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 9—September 2015
Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas
Middle East respiratory syndrome coronavirus (MERS-CoV) was originally described in 2012 in a patient with severe pneumonia in Saudi Arabia (1). The virus has been detected in several countries of the Middle East, causing acute respiratory disease and having a case-fatality rate of ≈35% (2). Although the exact epidemiology and mode of transmission remains ill-defined, MERS-CoV appears to be transmitted through respiratory droplets and most likely has zoonotic reservoirs in dromedary camels and possible origin in bats (1). Recent evidence suggests human infection results from repeated introduction of the virus from camels to humans, and less severe human-to-human transmission probably requires close contact with infected persons (2,3).
As of June 16, 2015, the World Health Organization (WHO) reported 1,293 laboratory-confirmed cases of MERS-CoV, of which 458 (35.4%) were fatal, with ongoing transmission in Saudi Arabia, an outbreak in South Korea and an imported case in Thailand (2). Reported cases are centralized in and around the Arabian Peninsula (Saudi Arabia, United Arab Emirates [UAE], Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, and Yemen); Saudi Arabia and UAE account for ≈95.8% of cases (2). Internationally, imported cases have been reported outside this zone (United Kingdom, France, Germany, Tunisia, Italy, Malaysia, Philippines, Greece, Egypt, United States, the Netherlands, Algeria, Austria, and Turkey) (2). Within Saudi Arabia and UAE, cases are predominantly localized to Jeddah, Riyadh, and Abu Dhabi, each of which operates a high-traffic airport that serves 17–26 million international travelers each year (4,5). To detect imported MERS-CoV cases, public health authorities in Ontario, Canada, advise testing of persons who have acute respiratory infection (ARI; i.e., symptoms and signs consistent with acute upper or lower respiratory tract infections) of any severity and recent travel to MERS-CoV–affected areas or of persons with ARI and recent close contact with ill travelers from affected areas (6).
Peak travel periods to Saudi Arabia (e.g., Ramadan, Umrah, or the Hajj) are of particular concern, although after the 2012 and 2013 Hajj, no MERS-CoV cases were identified in persons returning to France (7). High incidences of other respiratory diseases in pilgrims varied by year. In this study, we aimed to explore the array of respiratory pathogens in travelers with ARI returning to Ontario from MERS-CoV–affected areas or in their close symptomatic contacts.
Mr. German is an infectious disease epidemiologist at St. Michael’s Hospital in Toronto, Ontario. His research interests include global migration and emerging and re-emerging infectious disease.
We are thankful to Public Health Ontario and PHOL technical staff for support and help with data collection.
This work was funded by Public Health Ontario.
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Suggested citation for this article: German M, Olsha R, Kristjanson E, Marchand-Austin A, Peci A, Winter AL, et al. Acute respiratory infections in travelers returning from MERS-CoV–affected areas. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150472
1Current affiliation: St. Michael’s Hospital, Toronto, Ontario, Canada.
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