Response to Emergence of Middle East Respiratory Syndrome Coronavirus, Abu Dhabi, United Arab Emirates, 2013–2014

In January 2013, several months after Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia, Abu Dhabi, United Arab Emirates, began surveillance for MERS-CoV.We analyzed medical chart and laboratory data collected by the Health Authority-Abu Dhabi during January 2013-May 2014.Using realtime reverse transcription PCR, we tested respiratory tract samples for MERS-CoV and identified 65 case-patients.Of these patients, 23 (35%) were asymptomatic at the time of testing, and 4 (6%) showed positive test results for >3 weeks (1 had severe symptoms and 3 had mild symptoms).We also identified 6 clusters of MERS-CoV cases.This report highlights the potential for virus shedding by mildly ill and asymptomatic case-patients.These findings will be useful for MERS-CoV management and infection prevention strategies. M iddle East respiratory syndrome coronavirus(MERS-CoV) was first identified in October 2012 in Saudi Arabia (1).By November 6, 2015, the World Health Organization (WHO) had received reports of 1,611 cases and at least 575 deaths caused by MERS-CoV.Index cases that occurred outside the Arabian Peninsula all had a link to the region, such as recent travel (2-11).Most contact investigations outside the Arabian Peninsula have identified limited spread to additional persons (5,6,10), with the exception of the recent South Korea outbreak, in which 186 persons were infected (11).Within the Arabian Peninsula, clusters have been identified among extended families, households, and healthcare settings (12,13).Abu Dhabi is the largest emirate in the United Arab Emirates (UAE), with a diverse and mostly expatriate population of 2.3 million persons.The Health Authority-Abu Dhabi (HAAD) is the healthcare sector regulatory body and the custodian of public health in the emirate.In this role, HAAD directs the public health response for MERS-CoV, in conjunction with the UAE Ministry of Health.The Emirate of Abu Dhabi has 3 regions: the Western Region, which borders Saudi Arabia; Abu Dhabi, which includes a large, mostly urban population; and the Eastern Region, which borders Oman.Given the emirate's proximity to Saudi Arabia, HAAD created a standardized public health response protocol for MERS-CoV in January 2013 with the following objectives: 1) educate physicians by circulating regular instructions to all healthcare facilities, which contained WHO definitions for confirmed and probable cases and the mechanism for handling suspected cases and reporting to HAAD; 2) ensure laboratory capacity to test for MERS-CoV; and 3) add reporting options for MERS-CoV to existing electronic surveillance systems or create new surveillance systems to detect MERS-CoV.This article describes the public health response to the emergence of MERS-CoV in the region and epidemiologic characteristics of patients with laboratoryconfirmed MERS-CoV infection in Abu Dhabi during Jan-