Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013-2015

Int J Infect Dis. 2016 Jun;47:10-4. doi: 10.1016/j.ijid.2016.04.016. Epub 2016 Apr 23.


Background: Over 25000 pilgrims from the UK visit Saudi Arabia every year for the Umrah and Hajj pilgrimages. The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea and the continuing reports of MERS-CoV cases from Saudi Arabia highlight the need for active surveillance for MERS-CoV in returning pilgrims or travellers from the Middle East. Public Health England Birmingham Laboratory (PHEBL) is one of a few selected UK public health laboratories responsible for MERS-CoV screening in travellers returning to the UK from the Middle East who present to hospital with severe respiratory symptoms. The results of the PHEBL MERS-CoV screening and surveillance over the past 3 years is presented.

Methods: UK travellers/pilgrims who returned from the Middle East and presented to a hospital with respiratory symptoms were studied over the period February 1, 2013 to December 31, 2015. Patients with respiratory symptoms, who satisfied the Public Health England MERS-CoV case algorithm, were tested for MERS-CoV and other respiratory tract viruses on admission to hospital.

Results: Two hundred and two patients suspected of having MERS-CoV were tested. None of them had a laboratory-confirmed MERS-CoV infection. A viral aetiology was detected in half (50.3%) of the cases, with rhinoviruses, influenza A (H1N1 and H3N2), and influenza B being most frequent. Peak testing occurred following the annual Hajj season and in other periods of raised national awareness.

Conclusions: Respiratory tract infections in travellers/pilgrims returning to the UK from the Middle East are mainly due to rhinoviruses, influenza A, and influenza B. Whilst MERS-CoV was not detected in the 202 patients studied, heightened awareness of the possibility of MERS-CoV and continuous proactive surveillance are essential to rapidly identify cases of MERS-CoV and other seasonal respiratory tract viruses such as avian influenza, in patients presenting to hospital. Early identification and isolation may prevent outbreaks in nosocomial settings.

Keywords: Mass gatherings; Middle East respiratory syndrome coronavirus (MERS-CoV); Pilgrimage; Respiratory viruses; Surveillance.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Coronavirus Infections / epidemiology*
  • Cross Infection / epidemiology
  • Disease Outbreaks
  • England
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype
  • Influenza A Virus, H3N2 Subtype
  • Influenza, Human / epidemiology
  • Male
  • Middle Aged
  • Middle East / epidemiology
  • Middle East Respiratory Syndrome Coronavirus* / isolation & purification
  • Prospective Studies
  • Republic of Korea
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / virology
  • Rhinovirus
  • Saudi Arabia / epidemiology
  • Travel*
  • United Kingdom
  • Young Adult