WHO MERS Update – March 6th

Coronavirus – Credit CDC PHIL

 

# 9789

 

The World Health Organization has published an update detailing 10 recent MERS cases (from Feb 23rd-25th) - and among those are several (#1, #2 & #4) who may have contracted the virus while in a hospital – but if so, the exact route of exposure and infection remains unclear.

 

This continues a pattern we’ve seen described for a handful of patients over the last couple of WHO Updates, where exposure appears to have occurred in a hospital environment, but where there were no obvious epidemiological links to known case.

Cases  #7, #9 & #10 below did have known exposure to a known MERS infected case.  

 

 

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
6 March 2015

Between 23 and 25 February 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 10 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Cases are listed by date of reporting, with the most recent case listed first.

Details of the cases are as follows:

1. A 56-year-old male from Afif city developed symptoms on 22 February while admitted to hospital since 2 February due to unrelated medical conditions. On 17 February, the patient was admitted in the same ICU as a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 36); however, he was not treated by the same health workers. The patient was frequently visited by relatives and friends. Currently, he is in critical condition in ICU.
2. An 84-year-old male from Al-Oyuon city developed symptoms on 21 February and was admitted to hospital on 22 February. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
3. A 24-year-old female from Riyadh city developed symptoms on 19 February while admitted to hospital since 31 January due to unrelated medical conditions. The patient was admitted to the same hospital as a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 16 February (case n. 4); however, she was not treated by the same health workers and there is no epidemiological link with that case. The patient was frequently visited by relatives and friends. She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in critical condition admitted to ICU.
4. An 80-year-old male from Riyadh city developed symptoms on 21 February while admitted to hospital since 14 August 2014 due to unrelated medical conditions. The patient was admitted to the same hospital as a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 2); however, he had no direct contact with that case. The patient was frequently visited by relatives and friends. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in critical condition in ICU.
5. An 83-year-old male from Alrass city developed symptoms on 16 February and was admitted to hospital on 17 February but he discharged himself against medical advice on the same day. He travelled to Riyadh to seek another medical advice on 21 February and was admitted to hospital on the same day. He has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
6. A 75-year-old male from Riyadh city developed symptoms on 12 February and was admitted to hospital on 22 February. The patient has comorbidities. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in critical condition in ICU.
7. A 45-year-old, non-national male from Najran city developed symptoms on 13 February and was admitted to hospital on 20 February. The patient has no comorbidities. He is a contact of a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 17). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition admitted to a negative pressure isolation room on a ward.
8. A 65-year-old, non-national female from Jeddah city developed symptoms on 17 February and was admitted to hospital on 22 February. The patient has comorbidities. She has no history of exposure to any of the known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in critical condition in ICU.
9. A 50-year-old, non-national, male health worker from Riyadh city developed symptoms on 13 February and was admitted to hospital on 20 February. The patient is a smoker but has no comorbidities. He treated a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 10). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in stable condition admitted to a negative pressure isolation room on a ward.
10. A 62-year-old, non-national, female health worker from Riyadh city developed symptoms on 16 February and was admitted to hospital on 18 February. The patient has comorbidities. She treated a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 23 February (case n. 10). The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, she is in stable condition admitted to a negative pressure isolation room on a ward.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 previously reported MERS-CoV cases. The cases were reported in a previous DON on 23 February (cases n. 19, 37).

Contact tracing of household contacts and healthcare contacts is ongoing for these cases.

Globally, WHO has been notified of 1040 laboratory-confirmed cases of infection with MERS-CoV, including at least 383 related deaths.

 

Despite more than two years experience dealing with this novel coronavirus, and a series of MOH inspired infection control crackdowns, the Saudi Healthcare system still finds preventing  its transmission in the healthcare environment a serious challenge.

 

While nosocomial transmission has helped to drive many of the larger outbreaks of this virus, for more than half of the cases there is no obvious chain of infection.  A small percentage appear to be linked to animal (mostly camel) exposure, but the rest are a mystery.

 

Normally we’d get answers to these questions from a a case-control study, where epidemiologists would compare laboratory-confirmed cases to a large number of controls, matched for age, sex, and by neighborhood.

 

By examining their respective exposures against their outcomes, patterns of risk are often revealed.

 

In the summer of 2013 the World Health Organization published a framework for just such a project on MERS (see case-control study protocol), and entreated the Saudi Ministry of Health to conduct, and publish, the study. While repeated promises have been made (see KSA Announces Start To Long-Awaited MERS Case Control Study), for whatever reason, we’ve yet to see the results.

 

Until the behavior of this virus can be better understood,. the World Health Organization offers the following advice:

 

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.