Friday, August 26, 2016

WHO MERS-CoV Update - Thailand


Roughly a month ago Thailand announced their 3rd imported case of MERS from the Middle East in the past year - an 18 year old Kuwaiti male who had entered the country with two older relatives - followed 48 hours later by reports that repeat tests were negative.

According to a Bangkok Post report (LINK) this case was considered `probable' because one lab returned a positive lab result, while several others were inconclusive.

According to today's WHO update, he actually tested positive in three separate laboratory tests on the 28th, pretty much eliminating any doubts he was infected. He cleared the virus quickly, however, and by the 31st had tested negative, and he (and his companions) were discharged on August 4th

This update from WHO.

Middle East respiratory syndrome coronavirus (MERS-CoV) – Thailand

Disease outbreak news
26 August 2016

On 30 July 2016, the Ministry of Public Health, Thailand, announced a laboratory confirmed case of Middle East Respiratory Syndrome (MERS-CoV) in an 18-year-old Kuwaiti man who arrived in Thailand on 25 July with his family.

The patient developed symptoms on 25 July during a flight from Kuwait to Bangkok. On 26 July he sought medical treatment at a hospital in Bangkok. Although there was no history of direct contact with camels or with a suspected human case of MERS-CoV infection, he had a history of travel in the Middle East in the previous 14 days. On 28 July, he tested positive for MERS-CoV in three separate laboratories.

He was then referred and admitted to an isolation ward in the national referral hospital for infectious diseases.

The patient's condition rapidly improved and two subsequent laboratory tests on 31 July and 1 August returned negative results for MERS-CoV from four reference laboratories. Specimens collected from his family contacts were also negative. Contact tracing showed no evidence of infection in identified contacts.

The patient was discharged from hospital and left Thailand with his family on 4 August.

WHO risk assessment

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has caused severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans especially in health care settings with the potential to lead to large scale outbreaks. Nevertheless the risk of human to human transmission is low if adequate infection prevention and control measures are taken.

Infection with novel coronavirus is an emerging disease in humans. Imported MERS CoV cases had been reported in Thailand before (June 2015 and January 2016). The source of infection is most likely outside of Thailand. Exported cases have been detected in the past in several other countries.

WHO does not recommend that any travel or trade restriction be applied on Thailand based on the information currently available for this event.

WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a health care setting). The notification of additional cases does not change the overall risk assessment. WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

(Continue . . . )

Despite a lack of warning signs:
  • Displaying only flu-like symptoms
  • Age of 18
  • Reporting no camel contact
  • And traveling from Kuwait - which last reported a MERS case (just their 4th) - in September of 2015

Thailand's medical system - having already seen two imported cases - treated this case as a potential MERS case early on, and in the end that turned out to be the right decision.  

A reminder that on any given day, at any given hospital, a MERS, Ebola, or Avian flu patient can walk through the door, and how they are initially handled can mean the difference between Thailand's outcome and what we saw happen in South Korea last year. 

For more on how hospitals can prepare, you may wish to revisit  TFAH Issue Brief: Preparing The United States For MERS-CoV & Other Emerging Infections.

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