Credit WHO Summary Update #13
# 8194
The World Health Organization has today published a 5-page (PDF file) summary update on the MERS coronavirus, along with selected MERS-CoV Literature, and upcoming MERS-CoV Activities and guidance.
Included are new details on the two `probable’ MERS cases detected in Spain last November (see Spain Reports First MERS-CoV Case & Spain: MOH Statement On MERS-CoV Case).
Due to its length I’ve only included some excerpts. Follow the link for the entire document, and links to guidance, recent additions to the literature, and WHO MERS related activities.
Since April 2012, 178 laboratory-confirmed of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO, including 76 deaths (Figure 1). The median age of all lab-confirmed cases (n=178) is 52 years; this varies by the presumed type of exposure. For primary cases, those who have no history of exposure to other human cases, median age is 58 years; for secondary cases, those who appear to have been infected by other humans, median age is 44 years. Overall, 62% are male; distribution by sex also varies by presumed exposure 76% male among primary cases; 53% among secondary cases). To date, affected countries in the Middle East include Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates UAE)and; in Europe countries affected include: France, Germany, Italy and the United Kingdom (UK) and; and in North Africa: Tunisia. All cases have a link to the Middle East. For those cases reported outside the Middle East, the link is either through recent travel to the region or exposure to a patient who acquired infection in the region. Since the last update of 22 November 2013, 21 laboratory-confirmed cases, including seven deaths, were reported to WHO. The geographic distribution of these 21 cases is 14 cases, including four deaths, from Saudi Arabia; six cases, ncluding two deaths, from UAE; and one fatal case from Oman (Figure 2).Among the six new cases reported from UAE, three were from one family in Abu Dhabi, including a 32-year-old pregnant woman who died on 2 December 2013. Before her death, the woman gave birth to a healthy baby, who had no evidence of MERS-CoV infection. One of the recent cases from UAE was a 33-year-old health care worker who provided direct care for a 68-year-old patient with laboratory-confirmed MERS-CoV infection. The health care worker subsequently developed severe disease requiring mechanical ventilation and haemodialysis, and died.
Among the new cases reported from Saudi Arabia, seven are classified as sporadic (no contact with a probable or confirmed MERS-CoV patient) and seven as secondary cases (infection presumed to be acquired by transmission from another human case). Of the seven secondary cases, six are health care workers who were reported to be asymptomatic.
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Summary assessment
Infections acquired in health care facilities currently account for more than half of secondary cases. Health care workers and other patients in contact with cases both appear to be at risk. Thus far, transmission in health care facilities does not appear to persist over long periods of time or extend into the community. Most secondary cases who acquired infection in this setting have been mild or asymptomatic; however, several have had severe disease and have died, including workers who provided care for infected patients. Health care providers should be reminded of the need for universal precautions and for infection control measures to be implemented even before the cause of a patient’s illness has been determined. Patients for whom clinical suspicion of MERS-CoV is high should be managed as potentially infected, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the clinical and epidemiological picture suggests MERS-CoV when initial testing is negative, preferably on specimens from the lower respiratory tract. Infection control guidelines for both home care settings and health care facilities can be found on the WHO MERS-CoV website.Despite the initial report of probable MERS-CoV cases in Spain, follow-up laboratory testing was unable to confirm MERS-CoV infection in these two patients using specific RT-PCR assays. The women, who had been on an extended visit to Saudi Arabia, raised initial concerns about possible infection related to the pilgrimage of Hajj, which occurred 13 to 18 October 2013. However, other than these two unconfirmed cases, there were no other reports of Hajj-related MERS-CoV patients, despite extensive testing in nearly every country from which Hajj pilgrims originated. At this point, it is clear that neither significant transmission nor exportation of MERS-CoV occurred in association with the Hajj.
The confirmation of MERS-CoV virus in camels in Qatar supports an earlier report of MERS-CoV in a camel in Saudi Arabia and serologic evidence of MERS-CoV in camels from Canary Islands, Egypt, Jordan, Oman and UAE. The earliest findings of antibodies in camels from 2003 in UAE suggest that a similar virus has been circulating in animals for at least a decade. However, most primary human cases do not have a history of direct exposure to animals. More work is needed to determine the route of transmission to humans and the types of exposures that result in infection.
