Global & Disaster Medicine

Archive for the ‘MERS-CoV’ Category

Investigating a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia

Van Kerkhove MD, Aswad S, Assiri A, Perera RAPM, Peiris M, El Bushra HE, et al. Transmissibility of MERS-CoV infection in closed setting, Riyadh, Saudi Arabia, 2015. Emerg Infect Dis. 2019 Oct [date cited]. https://doi.org/10.3201/eid2510.190130

“…..We hypothesize that the increased human-to-human transmission within villas resulted from the clustering of the women’s activities. For example, the same women who lived together typically ate and socialized together, worked together, and traveled to and from work together. These activities added to the likelihood of intense direct physical contact among the women and probably facilitated limited but effective human-to-human transmission within their residence.….”

 

 


WHO reviews the current state of MERS-CoV

WHO MERS Global Summary and Assessment of Risk

“…..Between 2012 and 30 June 2019, 2449 laboratory confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection were reported to WHO, of which 84.0% were reported by the Kingdom of Saudi Arabia.

In total, cases have been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia.  Males above the age of 60 with an underlying medical conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death.  To date, 845 individuals have died (crude CFR 34.5%).

Since the last global update published on 30 June 2018, 219 laboratory-confirmed cases of MERS-CoV from four countries were reported to WHO (204 from Saudi Arabia, 13 from Oman, 1 from the Republic of Korea, and 1 from the United Kingdom), of whom 53 (24.2%) have died.  Among these cases, 79.0% were male and the median age was 52 years old (IQR 39-65; range 16-94 years old).  The median age is similar to the median age of all cases reported to WHO since 2012 (52 years old, IQR 37-65).

At the time of writing, 49 of the 219 (22.4%) patients were reported as asymptomatic or having mild disease. At least one underlying condition was reported in 145 cases (66.2%) since the last update, including chronic renal failure, heart disease, diabetes mellitus, and hypertension…….”


MERS-CoV is known to spread more easily in healthcare settings

CIDRAP

“……Over the past year, a cluster of 61 cases in Wadi ad-Dawasir in February and March sickened 61 people, 14 of them health workers. The outbreak involved six healthcare facilities, and human-to-human spread occurred in two of them. Then in April, one of two unlinked clusters in Khafji resulted in 10 cases, 5 of them involving healthcare workers……

The main epidemiologic pattern for MERS-CoV (Middle East respiratory syndrome coronavirus) remains the same—many introductions from dromedary camels in the Middle East and secondary transmission in healthcare settings, the WHO said. Household transmission among close family members is still limited for unknown reasons, but healthcare-associated outbreaks in the region are occurring more often, are typically small, and can affect several hospitals…..”


Results from the world’s first phase 1 trial of a vaccine against MERS-CoV (Middle East respiratory syndrome coronavirus) demonstrated a strong immune response after two doses and a good safety profile.

Lancet

“…..Between Feb 17 and July 22, 2016, we enrolled 75 individuals and allocated 25 each to 0·67 mg, 2 mg, or 6 mg GLS-5300. No vaccine-associated serious adverse events were reported. The most common adverse events were injection-site reactions, reported in 70 participants (93%) of 75.

Overall, 73 participants (97%) of 75 reported at least one solicited adverse event; the most common systemic symptoms were headache (five [20%] with 0·67 mg, 11 [44%] with 2 mg, and seven [28%] with 6 mg), and malaise or fatigue (five [20%] with 0·67 mg, seven [28%] with 2 mg, and two [8%] with 6 mg). The most common local solicited symptoms were administration site pain (23 [92%] with all three doses) and tenderness (21 [84%] with all three doses). Most solicited symptoms were reported as mild (19 [76%] with 0·67 mg, 20 [80%] with 2 mg, and 17 [68%] with 6 mg) and were self-limiting. Unsolicited symptoms were reported for 56 participants (75%) of 75 and were deemed treatment-related for 26 (35%). The most common unsolicited adverse events were infections, occurring in 27 participants (36%); six (8%) were deemed possibly related to study treatment. There were no laboratory abnormalities of grade 3 or higher that were related to study treatment; laboratory abnormalities were uncommon, except for 15 increases in creatine phosphokinase in 14 participants (three participants in the 0·67 mg group, three in the 2 mg group, and seven in the 6 mg group). Of these 15 increases, five (33%) were deemed possibly related to study treatment (one in the 2 mg group and four in the 6 mg group).

Seroconversion measured by S1-ELISA occurred in 59 (86%) of 69 participants and 61 (94%) of 65 participants after two and three vaccinations, respectively. Neutralising antibodies were detected in 34 (50%) of 68 participants. T-cell responses were detected in 47 (71%) of 66 participants after two vaccinations and in 44 (76%) of 58 participants after three vaccinations. There were no differences in immune responses between dose groups after 6 weeks. At week 60, vaccine-induced humoral and cellular responses were detected in 51 (77%) of 66 participants and 42 (64%) of 66, respectively. ……”


Since 2012, Middle East respiratory syndrome (MERS) coronavirus has infected 2,442 persons and killed 842 worldwide.

CDC

Donnelly CA, Malik MR, Elkholy A, Cauchemez S, Van Kerkhove MD. Worldwide reduction in MERS cases and deaths since 2016. Emerg Infect Dis. 2019 Sep [date cited]. https://doi.org/10.3201/eid2509.190143

An electron micrograph showing spherical particles within the cytoplasm of an infected cell

 


Saudi Arabia has now reported 153 MERS-CoV cases for this year.

Saudi MOH

Health Events: Epi-week 25, 2019   م2019  ﻌﻟﺎم 25 ثاﺪﺣأ اﻷﺳﺒﻮع اﻟﻮﺑﺎﺋﻲ

Date  ﺦﻳرﺎﺘﻟا
Event#  ﻢﻗر ثﺪﺤﻟا
Description

اﻟﻮﺻﻒ
20/06/2019 19-1931
MERS from Madinah City: a 70-year-old male in Madinah city, Madinah region Contact with camels:  Yes Case classification: Primary Current status: Active
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﻤﺪﻳﺔﻨ اﻟﻤﻨﻮرة:    ﻣﻨﻄﻘﺔ ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﻤﺪﻳﻨﺔ اﻟ ةرﻮﻨﻤ 70 ﻞﺟر ﺒﻳﻎﻠ اﻟﻤﺪﻳﻨﺔ اﻟﻤﻨﻮرة ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ :ﻢﻌﻧ ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا :ﺔﻴﻟوأ ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :ﺔﻄﺸﻧ
22/06/2019 19-1932


MERS from AlRass City: a 42-year-old male in AlRass city, Qassim region Contact with camels:  Yes Case classification: Primary Current status: Active
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ ﻟاسﺮ:    ﻣﻨﻄﻘﺔ اﻟﻘﺼﻴﻢ ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﺮس 42 ﻞﺟر ﺒﻳﻎﻠ ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ :ﻢﻌﻧ ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا :ﺔﻴﻟوأ ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :ﺔﻄﺸﻧ


A MERS-CoV outbreak in Wadi ad-Dawasir, Saudi Arabia: Since January, officials have identified 61 cases in the city, of which 14 were in health workers, and 37 were thought to involve healthcare exposure.

WHO

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

Disease Outbreak News: Update
24 April 2019

From 14 February through 31 March 2019, the National IHR Focal Point of Saudi Arabia reported 22 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including four deaths, associated with the outbreak in Wadi Aldwasir. Of the 22 cases, 19 were reported from Wadi Aldwasir city including two healthcare workers. The remaining three cases, which are epidemiologically linked to the outbreak, were healthcare workers from a hospital in Khamees Mushait city, Asir region.

Since the beginning of this outbreak in January 2019, a total of 61 MERS-CoV cases, with a case fatality ratio of 13.1% (8/61), have been reported in Wadi Aldwasir city. The median age of reported cases was 46 years (range 16 to 85 years). Of the 61 cases, 65% (n=46) were male, and 23% (n = 14) were health care workers. Investigations into the source of infection of the 61 cases found that 37 were health-care acquired infections, 14 were primary cases presumed to be infected from contact with dromedary camels and the remaining (10) infections occurred among close contacts outside of health care settings. As previously reported1, two human to human transmission amplification events took place at a hospital during this outbreak (one amplification event in the emergency department, and one amplification event in a cardiac intensive care unit; Figure 1).

The link below provides details of the 22 reported cases:

From 2012 through 31 March 2019, a total of 2399 laboratory-confirmed cases of MERS-CoV and 827 associated deaths were reported globally to WHO under the International Health Regulations (IHR). The associated deaths reported to WHO were identified through follow-up with affected member states.

Public Health Response

As reported previously, the Saudi Arabian Ministry of Health (MoH) has conducted and completed a full-scale investigation of the MERS outbreak in Wadi Aldwasir including identification of all household and healthcare worker contacts of confirmed patients in all of the hospitals affected.

As of 31 March 2019, a total of 380 contacts have been identified, including 260 household contacts and 120 healthcare worker contacts. All identified contacts were monitored for 14 days from the last date of exposure as per WHO and national guidelines for MERS. All secondary cases have been reported to WHO.

Currently, all the listed contacts have been tested for MERS-CoV infection by reverse transcription polymerase chain reaction (RT-PCR) at least once and many contacts of known patients have been tested repeatedly. All secondary cases of MERS-CoV infection have been reported to WHO. The last case from Wadi Aldwasir was reported on 12 March 2019.

Within the affected health care facilities, infection prevention and control measures have been enhanced including intensive mandatory on-the-job training on infection control measures for all healthcare workers in emergency room and intensive care unit. Disinfection has been carried out in the emergency room and ICU of hospital A, which is fully operational and additional staff were mobilized to support infection control activities. Respiratory triage has been enforced in all healthcare facilities in the Riyadh region.

The MoH media department launched an awareness campaign targeting Wadi Aldawasir city with special focus on camel owners and camel related activities.

The Ministry of Agriculture is testing dromedaries in Wadi Aldwasir city and initial results have identified several PCR positive dromedaries in the city. Positive camels have been removed from the market and movement in and out of the camel market has been restricted. Camels owned by confirmed human cases were quarantined regardless of testing results. Full genome sequencing of available human and dromedary specimens have been conducted. Laboratory findings of camel testing by the Ministry of Agriculture have been reported to the World Organization for Animal Health (OIE).

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high morbidity and mortality. Humans are infected with MERS-CoV from direct or indirect contact with infected dromedary camels or by transmission between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of these additional cases does not change WHO’s overall risk assessment of MERS. WHO expects that additional cases of MERS 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 dromedary camels, dromedary camel animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting or household contacts).

WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information. Results of the completed epidemiological investigation, as well as full genome sequencing of available dromedary and human specimens are being used by Ministry of Health officials to further evaluate the zoonotic and human-to-human transmission that has occurred in Wadi Aldwasir outbreak.

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 (IPC) 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 infection early because like other respiratory infections, the early symptoms of MERS are non-specific. Therefore, healthcare 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; airborne precautions should be applied when performing aerosol generating procedures.

Early identification, case management and isolation, together with appropriate infection prevention and control measures can prevent human-to-human transmission of MERS-CoV.

WHO recommends that comprehensive identification, follow up and testing of all contacts of MERS patients be conducted, if feasible, regardless of the development of symptoms since approximately 20% of all reported MERS cases have been reported as mild or asymptomatic. The role of asymptomatic MERS-CoV infection in transmission is not well understood. However, reports of transmission from an asymptomatic MERS patient to another individual have been documented.

MERS causes more severe disease in people with underlying chronic medical conditions such as diabetes mellitus, renal failure, chronic lung disease, and compromised immune systems. Therefore, people with these underlying medical conditions should avoid close unprotected contact with animals, particularly dromedary 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 camel’s raw milk or camel urine or eating camel 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.

1 Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia – 26 February 2019

 


Saudi Arabia’s MERS-CoV total for the year comes to 134 cases

Saudi MOH

22/04/2019 19-1911
MERS in Madinah city: 56-year-old male in Madinah city, Madinah region

Contact with camels: Unknown

Case classification: Primary

Current status: Active


Saudi MERS: 107 cases for 2019, including 57 linked to a large outbreak in Wadi ad-Dawasir in which most cases were linked to healthcare exposure.

Saudi MOH

Health Events: Epi-week 13, 2019 132019

Date التاريخ
Event# رقم الحدث
Description

الوصف
25/03/2019 19-1883
MERS in Khamees Meshait city: 61-year-old male in Khamess Meshait city, Aseer region Contact with camels: No Case classification: Primary Current status: Active

61
27/03/2019 19-1884
MERS in Alkharj city: 57-year-old male in Alkharj city, Riyadh region Contact with camels: Yes Case classification: Primary Current status: Active

57
27/03/2019 19-1885
MERS in Hufoof city: 60-year-old female in Hufoof city, Alhsa region Contact with camels: No Case classification: Primary Current status: Active


Saudi Arabia: From 1 through 28 February 2019, 68 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 10 deaths.

WHO

This Disease Outbreak News update describes the 19 cases. Among these cases, fifteen were sporadic, and four were reported as part of two unrelated clusters. Cluster 1 involved two cases in Buridah city; and Cluster 2 involved two cases in Riyadh city. The link below provides details of the 19 reported cases.

A separate Disease Outbreak News will provide an update on the outbreak in Wadi Aldwasir which affected 49 cases and resulted in seven deaths in February making a total of 52 cases since the onset of the outbreak.

From 2012 through 28 February 2019, the total number of laboratory-confirmed MERS cases reported globally to WHO is 2374 with 823 associated deaths. The global number reflects the total number of laboratory-confirmed cases reported to WHO under IHR to date. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high morbidity and mortality. Humans are infected with MERS-CoV from direct or indirect contact with infected dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans, especially from close unprotected contact with infected patients. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

The notification of these additional cases does not change WHO’s overall risk assessment of MERS. WHO expects that additional cases of MERS 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 dromedary camels, animal products (e.g. consumption of camel’s raw milk), or humans (e.g. in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

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 (IPC) 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 infection early because like other respiratory infections, the early symptoms of MERS are non-specific. Therefore, healthcare 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; airborne precautions should be applied when performing aerosol generating procedures.

Early identification, case management and isolation, together with appropriate infection prevention and control measures can prevent human-to-human transmission of MERS-CoV.

WHO recommends that comprehensive identification, follow up and testing of all contacts of MERS patients be conducted, if feasible, regardless of the development of symptoms since approximately 20% of all reported MERS cases have been reported as mild or asymptomatic. The role of asymptomatic MERS-CoV infection in transmission is not well understood. However, reports of transmission from an asymptomatic MERS patient to another individual have been documented.

MERS causes more severe disease in people with underlying chronic medical conditions such as diabetes mellitus, renal failure, chronic lung disease, and compromised immune systems. Therefore, people with these underlying medical conditions should avoid close unprotected contact with animals, particularly dromedary 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 camel’s raw milk or camel urine or eating camel 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.


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