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.
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.
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK. Electronic address: Sowsan.Atabani@phe.gov.uk.
Sowsan F
SF
Atabani
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
Steven
S
Wilson
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
Clare
C
Overton-Lewis
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
Judith
J
Workman
Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK.
I Michael
IM
Kidd
Aarhus University, Aarhus, Denmark; The Royal Hospital, Muscat, Oman.
Eskild
E
Petersen
Division of Infection and Immunity, University College London, London, and UK National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK.
Alimuddin
A
Zumla
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
Erasmus
E
Smit
Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
Husam
H
Osman
D000293:Adolescent; D000328:Adult; D000368:Aged; D018352:Coronavirus Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology; D004196:Disease Outbreaks; D004739:England; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D053122:Influenza A Virus, H3N2 Subtype; D007251:Influenza, Human / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D011446:Prospective Studies; D056910:Republic of Korea; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology; D012229:Rhinovirus; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel; D006113:United Kingdom; D055815:Young Adult
Mass gatherings; Middle East respiratory syndrome coronavirus (MERS-CoV); Pilgrimage; Respiratory viruses; Surveillance