Monday, July 28, 2014

MERS: The Price Of Vigilance



# 8874


Although there’s been a precipitous drop in the number of MERS cases reported by Saudi Arabia (and other) Middle Eastern nations over the past month, concerns remain that international travelers could carry the virus to other areas of the globe. 


While not always making headlines, many countries are engaged in testing for the virus among symptomatic travelers coming from the Middle East.  


Today, we’ve a report from Hong Kong’s CHP on three people being tested (1 has intially tested negative).  Over the past year Hong Kong has tested scores of travelers for MERS, and thus far, all have proved negative. First the report, then I’ll return with more:


Three suspected cases of MERS

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (July 28) investigating two suspected cases of Middle East Respiratory Syndrome (MERS) affecting a 34-year-old man and a 45-year-old woman, and called on the public to stay alert and maintain good personal, food and environmental hygiene during travel. In addition, the CHP provided an update on the suspected case of MERS notified yesterday (July 27). The 2-year-old boy's respiratory specimen tested negative for MERS Coronavirus (MERS-CoV).

The first patient is a 34-year-old man with good past health. He travelled from Pakistan to Hong Kong via Dubai yesterday and arrived in Hong Kong today. He has presented with fever and vomiting and was screened to have fever at the Hong Kong International Airport today. He was subsequently transferred to Princess Margaret Hospital for isolation. He is currently in stable condition.

The second patient is a 45-year-old woman with good past health. She returned to Hong Kong from Paris via Dubai on July 25 and arrived in Hong Kong on July 26. She has presented with fever and diarrhoea since yesterday and was admitted to Princess Margaret Hospital for isolation today. She is currently in stable condition.

Both patients' respiratory specimens have been collected for laboratory testing by the CHP's Public Health Laboratory Services Branch (PHLSB). Their travel collaterals have remained asymptomatic.

Regarding the suspected case of MERS notified yesterday, the 2-year-old boy's nasopharyngeal aspirate tested negative for MERS-CoV upon preliminary laboratory testing by the CHP's PHLSB. The patient travelled with his family from Dubai to Hong Kong on July 23. He has presented with fever since July 24 and cough since July 26. He was admitted to Princess Margaret Hospital on July 26 and has been in stable condition. His travel collaterals remain asymptomatic. 

"We strongly advise travel agents organising tours to the Middle East not to arrange camel rides and activities involving camel contact, which may increase the risk of infection. In addition, travellers are reminded to avoid going to farms, barns or markets with camels, and avoid contact with animals, especially camels, birds, poultry or sick people during travel," a spokesman for the DH said.

(Continue . . . .)


The odds are that these cases, like the ones before them, will test negative for the virus.  


But the truth is, as long as the virus continues to occasionally infect humans in the Middle East, public health officials in Hong Kong – and around the world – must be alert to the possibility that international travelers could be arriving with the virus.


A little over a week ago, in EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj, we looked at the extraordinarily high percentage of Hajjis (approx. 80%)  who leave Saudi Arabia with some type of respiratory infection.  The vast majority of these respiratory infections were due to either rhinoviruses or influenza, with a smaller number of cases of pneumonia.


While MERS wasn’t a major factor among religious pilgrims last year, since that time the number of MERS cases in Saudi Arabia has increased five-fold, and any traveler leaving the region who develops respiratory symptoms is urged to be screened for MERS-CoV.

Whether or not MERS infections surge during the Hajj, public health agencies around the world are going to be taxed by the sheer volume of symptomatic (with `something’) travelers returning from the Middle East this fall.   Most (hopefully, all) will have something mundane, like seasonal influenza or the common cold.


Hong Kong’s CHP is particularly pragmatic when it comes to the potential for seeing MERS arrive in their jurisdiction.  In their new release, they also advise:


Early identification of MERS-CoV is important, but not all cases can be detected in a timely manner, especially mild or atypical cases. Health-care workers (HCWs) should maintain vigilance and adhere to strict infection control measures while handling suspected or confirmed cases to reduce the risk of transmission to other patients, HCWs or visitors. Regular education should be provided.

Travellers returning from the Middle East who develop respiratory symptoms should wear face masks, seek medical attention and report their travel history to the doctor. HCWs should arrange MERS-CoV testing for them. Patients' lower respiratory tract specimens should be tested when possible and repeat testing should be undertaken when clinical and epidemiological clues strongly suggest MERS.


While having more MERS cases spreading internationally this fall would be a serious public health concern, just the threat of seeing the virus arrive poses a tremendous challenge for public health agencies around the world.


And this comes at a time when public health funding and staffing in the United States continues to erode (see TFAH report Investing in America’s Health: A State-by-state Look at Public Health Funding & Key Health Facts).


Even as funding for public health declines, the number of global disease threats only seems to be increasing. 

To MERS-CoV we can add H5N1, H7N9, Chikungunya, Dengue, Ebola, Lassa Fever,  CCHF, Polio, NDM-1, CRE, XDR-TB  . . .  and of course the one we don’t know about yet . . . Virus X.


Faced as we are with an ever expanding rogue’s gallery of pathological fliers, the recent cuts in public health spending are all the more difficult to fathom.  And are an economy we could easily come to regret.

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