Monday, April 24, 2017

WHO MERS Update - A Household Cluster In The UAE


On April 11th the UAE's Health Authority announced the detection of a single MERS case in Abu Dhabi, albeit with almost zero details provided.

Overnight, the Arabic media has carried reports (which I've been unable to verify off the HAAD website), saying the UAE's health authority has recently issued new, stronger guidelines for testing of respiratory samples.

Abu Dhabi Health" issued an updated standard for monitoring influenza

Date: April 24 2017   

The Health Authority in Abu Dhabi has issued a standard up to date to control and monitor the active influenza and diseases like influenza cases, and called on all health facilities and laboratories in the Emirate of Abu Dhabi to the need to follow the ways of dealing with similar symptoms of influenza cases and infection control in accordance with the instructions and standards body and prompt reporting electronically for any case applicable case definition sick infected with influenza, as well as laboratory results.

The Commission stressed that all health care facilities on the epidemiological investigation of the virus Middle respiratory center «Corona» syndrome and demanded to take all precautions with any confirmed or suspected to be infected with the virus case, and compliance with the directives guiding the World Health Organization regarding the verification and examination and taking into account the procedures for the prevention of infection and control of epidemic diseases acute respiratory symptoms, stressing the need to follow the due precautions in cases dealing with any patient suffering from symptoms similar to the flu.
         (Continue . . . )

While I was waiting for some official confirmation or further details on this story, the World Health Organization published details on the April 11th case, which we now learn involved two cases. The index patient, a 31 y.o. male who died, and a `household contact' who tested positive, but remained asymptomatic.
Asymptomatic MERS cases, once thought to be fairly rare, are turning up more often as more rigorous testing of contacts of known cases (see last summer's Saudi MOH On KKUH MERS Outbreak & Increased Asymptomatic Detections) has become policy in the Middle East. 

While suspected, the role of asymptomatic or mildly symptomatic cases in spreading the virus in the community remains unproven.   

Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates
Disease outbreak news
24 April 2017

Between 9 and 11 April 2017, the National IHR Focal Point of United Arab Emirates (UAE) reported two additional cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV). 

Details of the cases

The two cases identified in Abu Dhabi, UAE, were roommates. The case reported to WHO on 9 April 2017 (31-year-old) passed away on 16 April 2017 and the second case reported to WHO on 11 April 2017, identified through tracing of household contacts, is asymptomatic and has been admitted to a negative pressure isolation room on a ward in hospital. The source of infection of the 31-year-old MERS case is under investigation. Contact tracing of household and healthcare contacts is ongoing. Detailed information concerning the cases can be found in a separate document (see link below).
  MERS-CoV cases reported between 9 April and 11 April 2017
xlsx, 22kb

To date, United Arab Emirates has reported 81 laboratory confirmed cases of MERS. The last case was reported in June 2016 (see Disease Outbreak News published on 21 June 2016).

Globally, since September 2012, 1938 laboratory-confirmed cases of infection with MERS-CoV including at least 691 related deaths have been reported to WHO.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in health care settings.

The notification of additional cases does not change the overall risk assessment. 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). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

Although reported MERS activity has been fairly low across the Middle East this year, we've seen estimates that a lot more cases probably occur than are diagnosed.  This call by the UAE's Health Ministry for more rigorous testing of suspected MERS cases could go a long way towards firming up those estimates.

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