Tuesday, July 04, 2017

WHO MERS-CoV Update - Lebanon


A few days ago it emerged (see Crofsblog A belated MERS report from Lebanon) that a MERS case - apparently imported from Saudi Arabia - had turned up in Lebanon. Today, we've a detailed report on this incident from the WHO, which is only the second time that Lebanon has confirmed a MERS case.
The patient - a 39 y.o. Lebanese national, living in Riyadh, began experiencing mild symptoms on June 6th, and - despite no known exposure - was tested for MERS on June 1tth.  That test was negative. 
The patient returned home to Lebanon, where he was tested again on the 16th, and this time was PCR positive for the MERS virus. His illness was mild, and so he was placed in home isolation.  He has since recovered, and no local contacts appear to have been infected. 
Middle East respiratory syndrome coronavirus (MERS-CoV) – Lebanon
Disease outbreak news
4 July 2017

On 19 June 2017, the national IHR focal point of Lebanon reported one additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection.
Details of the case

Detailed information concerning the case reported can be found in a separate document (see link below).

A 39-year-old male Lebanese national living in Riyadh, Saudi Arabia developed mild symptoms on 8 June 2017. As the patient was a health care worker and due to enhanced Middle East respiratory syndrome (MERS) surveillance activities ongoing in Riyadh, a nasopharyngeal swab was collected on 11 June 2017 in Riyadh, Saudi Arabia, and tested negative for MERS-CoV by PCR at the Riyadh Regional Laboratory.
The case is without a history of comorbid conditions. He does not work in a health care facility with active MERS patients, has not had contact with an identified confirmed MERS case, nor has had known contact with a patient with respiratory illness. He has no history of contact with dromedaries in the 14 days prior to the onset of the symptoms.

On 11 June 2017, the case travelled from Saudi Arabia to Lebanon and reported that he had no symptoms while travelling. On 15 June, he developed gastrointestinal symptoms and a medical investigation was initiated on the same day in Lebanon, whereupon a chest X-ray confirmed the diagnosis of pneumonia.
A lower respiratory specimen was collected 16 June 2017 and tested positive for MERS-CoV. The case was reported to Ministry of Public Health on the same day. The case was placed in home isolation. The case has been asymptomatic since 17 June 2017, and two consecutive nasopharyngeal swabs and one lower respiratory sample were collected and tested negative for MERS-CoV by PCR, on 17, 19 and 23 June 2017, respectively. The patient was released from home isolation on 23 June 2017. All contacts in Lebanon have tested negative for MERS-CoV. Contact tracing in Saudi Arabia and the source of infection are under investigation by the Ministry of Health in Saudi Arabia.

Globally, 2037 laboratory-confirmed cases of infection with MERS-CoV including at least 710 related deaths have been reported to WHO.
Public health response

During the investigation of this case, the Ministry of Public Health evaluated the case and his contacts and implemented measures to limit further human-to-human transmission. These measures included:

  • Proper isolation for confirmed cases (home isolation for asymptomatic patients, and in hospital for symptomatic patients).
  • Active tracing for all contacts of patients, exposed health care workers and community contacts in Lebanon.
  • Identification and contact and follow up of contacts in Saudi Arabia and investigation into the patient’s source of infection, in collaboration with the Ministry of Health in Saudi Arabia.
  • Identification of high and low risk contacts among health care workers with daily monitoring for all during incubation period of the 14 days, and performing laboratory testing with nasopharyngeal swabs from all exposed health care workers, regardless of the development of symptoms. All tests among contacts have been negative.
  • Identification of high and low risk contacts among households with daily monitoring for all during incubation period of the 14 days, and PCR testing for symptomatic contacts. No symptoms were observed among household contacts.
  • Enforcement of infection prevention and control measures at the hospital.
  • Sending positive specimens to reference labs for confirmation and sequencing.
The Ministry of Public Health in Lebanon is communicating with the Ministry of Health in Saudi Arabia for follow up of health care workers and social contacts of the patient while he was in Saudi Arabia. The patient had not worked in a health care facility where recent MERS cases have been reported, but had initially been tested in Riyadh on 11 June 2017 as part of enhanced surveillance activities in Riyadh due to the clusters of MERS cases previously reported in the Disease Outbreak News published on 13 June 2017, 19 June 2017, and 28 June 2017.

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