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Volume 22, Number 4—April 2016

Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East

Cristina CariasComments to Author , Justin J. O’Hagan, Amy Jewett, Manoj Gambhir, Nicole J. Cohen, Yoni Haber, Nicki Pesik, and David L. Swerdlow
Author affiliations: IHRC, Inc., Atlanta (C. Carias, J.J. O’Hagan); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C. Carias, J.J. O’Hagan, A. Jewett, M. Gambhir, N.J. Cohen, Y. Haber, N. Pesik, D.L. Swerdlow); Monash University, Melbourne, Victoria, Australia (M. Gambhir)

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Table 3

Estimated annual number of symptomatic cases of MERS-CoV infection exported and likelihood of >1 exportation for countries outside the Middle East among source country residents traveling outside the Middle East*

Country of destination
Observed no. symptomatic cases exported
No. cases exported from source countries (95% CI); % likelihood for >1 exportation†
Italy‡ 0 0 (0–4); 1 0 (0–4); 18 NA 0 (0–4); 8
Malaysia§ 0 0 (0–4); 0 0 (0–4); 33 0 (0–4); 1 0 (0–4); 2
Tunisia‡ 0 0 (0–4); 0 0 (0–4); 2 0 (0–4); 0 0 (0–4); 0
United Kingdom§ 0 0 (0–4); 0 0 (0–4); 35 0 (0–4); 3 0 (0–4); 25
United States§ 2 from KSA 0 (0–4); 0 1 (0–5); 51 0 (0–4); 2 0 (0–4); 8

*The incubation period considered was 5.5 days (95% CI 3.6–10.2 days) (8). MERS-CoV, Middle Eastern respiratory syndrome coronavirus; KSA, Kingdom of Saudi Arabia; UAE, United Arab Emirates; NA, not available.
†Information on Middle Eastern visitors to France, Netherlands, and Greece was not available. Number of Middle Eastern residents visiting Algeria and Austria was not available by country of residence.
‡Number of Middle Eastern visitors traveling to Italy and Tunisia corresponds to persons whose nationality is that of Middle Eastern source countries.
§Number of Middle Eastern visitors traveling to Malaysia, the United Kingdom, and the United States corresponds to residents in the Middle East.

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  1. van Boheemen  S, de Graaf  M, Lauber  C, Bestebroer  TM, Raj  VS, Zaki  AM, Genomic characterization of a newly discovered coronavirus associated with acute respiratory distress syndrome in humans. MBio. 2012;3:e0047312 . DOIPubMed
  2. Zumla  A, Hui  DS, Perlman  S. Middle East respiratory syndrome. Lancet. 2015;386:9951007. DOIPubMed
  3. Drosten  C, Kellam  P, Memish  ZA. Evidence for camel-to-human transmission of MERS coronavirus. N Engl J Med. 2014;371:135960. DOIPubMed
  4. Assiri  A, McGeer  A, Perl  TM, Price  CS, Al Rabeeah  AA, Cummings  DA, Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369:40716. DOIPubMed
  5. Memish  ZA, Zumla  AI, Al-Hakeem  RF, Al-Rabeeah  AA, Stephens  GM. Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med. 2013;368:248794 . DOIPubMed
  6. Perlman  S, McCray  PB Jr. Person-to-person spread of the MERS coronavirus—an evolving picture. N Engl J Med. 2013;369:4667. DOIPubMed
  7. Bialek  SR, Allen  D, Alvarado-Ramy  F, Arthur  R, Balajee  A, Bell  D, First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities—May 2014. MMWR Morb Mortal Wkly Rep. 2014;63:4316 .PubMed
  8. Cauchemez  S, Fraser  C, Van Kerkhove  MD, Donnelly  CA, Riley  S, Rambaut  A, Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility. Lancet Infect Dis. 2014;14:506. DOIPubMed
  9. Fraser  C, Donnelly  CA, Cauchemez  S, Hanage  WP, Van Kerkhove  MD, Hollingsworth  TD, Pandemic potential of a strain of influenza A (H1N1): early findings. Science. 2009;324:155761 .PubMed
  10. Balcan  D, Gonçalves  B, Hu  H, Ramasco  JJ, Colizza  V, Vespignani  A. Modeling the spatial spread of infectious diseases: the Global Epidemic and Mobility computational model. J Comput Sci. 2010;1:13245. DOIPubMed
  11. Daniel  WB, Hengartner  NW, Rivera  MK, Powell  DR, McPherson  TN. An epidemiological model of spatial coupling for trips longer than the infectious period. Math Biosci. 2013;242:18. DOIPubMed
  12. Khan  K, Sears  J, Hu  VW, Brownstein  JS, Hay  S, Kossowsky  D, Potential for the international spread of Middle East respiratory syndrome in association with mass gatherings in Saudi Arabia. PLoS Curr. 2013;5:pii:ecurrents.outbreaks.a7b70897ac2fa4f79b59f90d24c860b8.
  13. Lessler  J, Rodriguez-Barraquer  I, Cummings  DA, Garske  T, Van Kerkhove  M, Mills  H, Estimating potential incidence of MERS-CoV associated with Hajj pilgrims to Saudi Arabia, 2014. PLoS Curr. 2014;6:pii:ecurrents.outbreaks.c5c9c9abd636164a9b6fd4dbda974369.
  14. Müller  MA, Meyer  B, Corman  VM, Al-Masri  M, Turkestani  A, Ritz  D, Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. Lancet Infect Dis. 2015;15:55964. DOIPubMed
  15. Korea Centers for Disease Control and Prevention. Middle East respiratory syndrome coronavirus outbreak in the Republic of Korea, 2015. Osong Public Health Res Perspect. 2015;6:269–78.

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