Investigation of an imported case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in Florence, Italy, May to June 2013

Abstract

On 31 May 2013, the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in Italy was laboratory confirmed in a previously healthy adult man, who developed pneumonia with moderate respiratory distress after returning from a holiday in Jordan. Two secondary cases were identified through contact tracing, among family members and colleagues who had not previously travelled abroad. Both secondary cases developed mild illness. All three patients recovered fully.

Middle East respiratory syndrome coronavirus (MERS-CoV) RNA and neutralising antibodies in milk collected according to local customs from dromedary camels, Qatar, April 2014

“…While the source or reservoir of MERS-CoV is unknown, the disease is transmitted from person to person, for example by close contacts or in healthcare facilities [17][18][19][20][21][22][23][24]. Based on information related to the first 77 cases, the basic reproduction number of the infection (R0) was estimated to be 0.69 (95% CI 0.50-0.92) at the time [25], indicating a low pandemic potential [26].…”

Middle East Respiratory Syndrome (MERS)

“…5,9,10,12,14 Human to human transmission of MERS-CoV has been reported in several clusters of cases in different countries including among family members and health care workers. [13][14][15][16][17] For MERSCoV, asymptomatic infections have recently been identified in children and health workers. However, whether these individuals can efficiently transmit infection is still unclear.…”

Middle East respiratory syndrome coronavirus: epidemic potential or a storm in a teacup?

“…All cases are linked to only six countries in the Middle East: KSA, Jordan, Kuwait, Oman, Qatar and UAE. Five countries outside the Arabian Peninsula (France, Italy, Germany, Tunisia and the UK) have detected MERS cases that were either transferred for care or travellers returning from one of the Middle East countries and subsequently became ill [12][13][14][15][16][17][18]. Four countries (Italy, France, Tunisia and the UK) have reported endemic secondary cases arising from local transmission linked to the initial imported case.…”

“…Four countries (Italy, France, Tunisia and the UK) have reported endemic secondary cases arising from local transmission linked to the initial imported case. The clusters in Italy [18], the UK [13], France [14] and Tunisia [24] have been linked to infection from a returning traveller and transmission So, what is the potential of MERS-CoV to cause a pandemic? When first discovered over 18 months ago, it was unknown whether MERS-CoV would remain a disease restricted to the Middle East, with intermittent, sporadic outbreaks, or progress to becoming a global pandemic, or burn out with time.…”

“…As of April 1, 2013, there were only small numbers of MERS cases and obtaining meaningful research data was limited only to case reports [2,[11][12][13][14][15][16][17][18][19]. The KSA and other Middle Eastern governments kept proactive, watchful surveillance with immediate reporting to the World Health Organization (WHO) of MERS cases.…”