Tuesday, June 09, 2015

WHO Risk Assessment For MERS In Europe

MERS Cases Outside Of the Middle East Before Korea - Credit ECDC

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Since the MERS virus was first detected three years ago we've seen the virus exported to more than a dozen non-Middle Eastern nations, but only rarely have secondary infections resulted (in France, Iran, and the UK) and only in a very limited way.

For reasons that are not yet clear, Korea is an outlier.

It has been suggested that the cultural practice of going to more than one hospital to seek a second (and sometimes a 3rd or 4th) medical opinion has driven this outbreak. It is also possible that the more temperate climate, and higher humidities in Korea are aiding in its transmission (the virus is supposedly most stable at 20C and 40 RH).

There are, frankly, a lot of possibilities. 

And it may well be that combination of several factors, along with some bad luck, have exacerbated this outbreak.  The good news is, that unlike with Saudi Arabia, I doubt we'll have to wait three years (and counting) for the results of a case-control study.

Today the WHO's European Office has issued a risk assessment for European nations that grants that there remains a risk for seeing imported cases coming out of the Middle East (and now Korea), but that the risk for for spread within Europe are low.

MERS-CoV in the Republic of Korea: risk for importation remains, but low risk for spread within Europe 
Republic of Korea reports the largest MERS-CoV outbreak outside the Arabian Peninsula
The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Republic of Korea continues to unfold since the first case was reported on 20 May 2015.  
While the occurrence of such a large outbreak outside the Middle East is a new development, there is currently no indication that the virus is behaving differently than elsewhere. Like previous outbreaks, the outbreak in the Republic of Korea is associated with transmission in the health care setting and among close family contacts; so far, there is no evidence of sustained community transmission. Therefore, the overall pattern of infection observed previously remains unchanged.  
WHO is guiding the public health response in both the Republic of Korea and the other affected countries, in collaboration with partners. The response includes ensuring proper treatment of patients, preventing further cases and gaining a better understanding of transmission patterns and risk factors in this outbreak. WHO is monitoring the situation and remains vigilant.
MERS-CoV has been reported in the European Region 
Since September 2012, 15 laboratory-confirmed cases of MERS-CoV infection, including 7 related deaths, have been reported by eight countries in the WHO European Region (Austria, France, Germany, Greece, Italy, The Netherlands, Turkey and the United Kingdom). Most of the cases were imported and did not result in further spread of the virus: in only three cases was there secondary transmission to family members or contacts. The last case was reported in Germany in March 2015. 
The risk that another traveller infected with MERS-CoV will enter the European Region remains. Every day, there are many travellers between Europe and the countries that are currently reporting MERS-CoV cases. Experience has shown, however, that European countries are prepared to deal with imported cases of MERS-CoV, including laboratory capacity to detect MERS-CoV, treatment facilities equipped with isolation wards and arrangements for contact tracing. In particular, consistent application of adequate measures to prevent infection and other public health measures has obviated or mitigated transmission.
WHO recommends that European countries be highly vigilant 
WHO encourages all countries in the European Region to be vigilant, strengthen their surveillance for acute respiratory infections, especially among travellers or migrant workers returning from the Middle East, and carefully review any unusual patterns. The WHO Regional Office for Europe stands ready to support countries in assessing their capacity to respond to MERS-CoV and to provide technical assistance to scale up preparedness.   
Adherence to infection prevention and control measures in health care settings 
It is difficult to identify patients with MERS-CoV early, because the symptoms are similar to those of other respiratory infections. In order to mitigate the risk for transmission to people who might be exposed to MERS-CoV (health care workers treating a MERS-CoV-infected patient), strict adherence to infection prevention and control measures is vital. 
Health care workers caring for patients with probable or confirmed MERS-CoV infection should use precautions against contact and droplets—medical mask, eye protection, gown and gloves—in addition to standard precautions. 
Public health advice to travellers
Travellers to and from currently affected countries should receive public health advice on MERS-CoV. 
  • Travellers to affected countries, particularly people with pre-existing medical conditions and the elderly, should avoid close contact with animals, especially camels, and follow strict hygiene measures, such as regular hand-washing.
  • People should avoid drinking raw camel milk or camel urine or eating meat that has not been adequately cooked.
  • Travellers back to Europe should report any acute respiratory illness to medical staff during 2 weeks (incubation period) after their return and inform the staff about their recent travel. Eliciting a travel history from patients with severe respiratory disease is crucial for detecting cases.
WHO does not recommend the application of any travel or trade restrictions or entry screening related to MERS-CoV.

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