Global & Disaster Medicine

Archive for the ‘MERS-CoV’ Category

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.


A review: Dromedary camels as the main reservoir for human Middle East respiratory syndrome (MERS) infections.

Sikkema, R., Farag, E., Islam, M., Atta, M., Reusken, C., Al-Hajri, M., & Koopmans, M. (2019). Global status of Middle East respiratory syndrome coronavirus in dromedary camels: A systematic review. Epidemiology and Infection, 147, E84. doi:10.1017/S095026881800345X

“…..In general, camels only show minor clinical signs of disease after being infected with MERS-CoV. Serological evidence of MERS-CoV in camels has been found in 20 countries, with molecular evidence for virus circulation in 13 countries. The seroprevalence of MERS-CoV antibodies increases with age in camels, while the prevalence of viral shedding as determined by MERS-CoV RNA detection in nasal swabs decreases. In several studies, camels that were sampled at animal markets or quarantine facilities were seropositive more often than camels at farms as well as imported camels vs. locally bred camels. Some studies show a relatively higher seroprevalence and viral detection during the cooler winter months. …..”

 


Saudi Arabia: 102 cases since the first of the year, of which 57 are linked to the outbreak in Wadi ad-Dawasir, most of which are linked to healthcare exposure, with some related to contact with camels.

Saudi MOH

Health Events: Epi-week 11, 2019 112019

Date التاريخ
Event# رقم الحدث
Description

الوصف
10/03/2019 19-1874
MERS in Hafr Albatin city: 47-year-old male in Hafr Albatin city, Hafr Albatin region Contact with camels: Yes Case classification: Secondary Current status: Active

47
10/03/2019 19-1875
MERS in Khamees Meshait city: 64-year-old female in Khamees Meshait city, Aseer region Contact with camels: No Case classification: Secondary Current status: Active

64
11/03/2019 19-1876
MERS in Wadi Aldwasir city: 60-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: No Case classification: Secondary Current status: Active

 


MERS-CoV in Oman: 8 new cases

WHO

Disease outbreak news
4 March 2019

Between 12 and 18 February 2019, the National IHR Focal Point of Oman reported eight additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Four cases were reported from South Sharquia governorate, and four cases were reported from North Batinah governorate where a MERS-CoV cluster was recently identified. Details of the additional eight cases can be found in the attached excel sheet.

Since 27 January 2019, a total of 13 MERS cases were reported from Oman, including nine from North Batinah (five cases were previously reported in the Disease outbreak News 11 February 2019) and four from South Sharquia.

An investigation into the exposure history to known risk factors in the 14 days prior to symptom onset in all eight cases is currently ongoing.

From 2012 through 18 February 2019, a total of 2357 laboratory-confirmed cases of MERS, along with 820 associated deaths, have been reported to WHO globally. The first reported MERS infection in Oman was reported in 2013. Since then, a total of 24 cases and seven deaths have been reported.

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.

Public Health response

Whole genome sequencing of available human specimens of patients is being conducted. As of 21 February, all identified contacts (family and health workers) of confirmed MERS patients have been screened, including 69 contacts from North Batinah patients and 57 contacts from South Sharqiyah patients. Tracing and follow-up of these contacts is ongoing by the Ministry of Health for 14 days from the last date of exposure as per WHO and national guidelines for MERS-CoV. All contacts have been sampled and have tested negative for MERS-CoV by RT-PCR.

The Ministry of Agriculture has conducted an investigation of dromedaries at the farms of one of the patients. Results of this investigation are pending.

The Ministry of Health has strengthened infection prevention and control measures in emergency departments, especially in triaging areas. Health education and awareness materials were produced and disseminated to health care staff, patients and visitors.

Family members of MERS-CoV infected patients have been contacted and advised about the virus and on measures to ensure personal protection to prevent infection. Efforts in improving public health awareness among the general public has been strengthened through greater messaging in the media.

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-CoV. WHO expects that additional cases of MERS 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 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 measures are critical to prevent the possible spread of MERS-CoV between people 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 infection; 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 infections have been reported as mild or asymptomatic. The role of asymptomatic MERS infection in transmission is not well understood. However, reports of transmission from an asymptomatic MERS infected patient to another individual have been documented.

MERS causes more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, these people should avoid close contact with 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 raw camel milk or camel urine, and refrain from eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regards to this event, and does not currently recommend the application of any travel or trade restrictions at this time.


The Saudi MOH has now confirmed 65 MERS infections since Jan 1

18/02/2019 19-1841
MERS in Wadi Aldwasir city: 53-year-old male in Wadi Aldwasir city, Riyadh region

Contact with camels: Yes

Case classification: Primary

Current status: Hospitalized

 


Another MERS case in Saudi Arabia, making it 62 for the year

WHO

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

Disease outbreak news
15 February 2019

From 1 January through 31 January 2019, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported fourteen additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths. Details of these cases can be found by following the link to a separate document after this paragraph. Of the 14 cases reported in January, eight are from three separate clusters of cases. Cluster 1 involves three cases (listed as cases 1, 2 and 3) in Riyadh Province and cluster 2 involves two cases (listed as cases 4 and 5) in the city of Jeddah. Cluster 3 involves three cases (listed as cases 11, 13 and 14) in the city of Wadi Aldwaser and is currently ongoing. More details regarding the outbreak in Wadi Aldwaser and the implementation of interventions by the Ministry of Health (MoH) in Saudi Arabia will be provided in the next update.

Saudi Arabia

The link below provides details of the fourteen reported additional cases.

From 2012 through 31 January 2019, the total number of laboratory-confirmed MERS-CoV cases reported globally to WHO under IHR (2005) is 2 298 with 811 associated deaths. 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 mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

As of 15 February 2019, there is an ongoing outbreak of MERS in Wadi Aldwaser, which includes cases 11, 13 and 14 reported in the separate document linked above. WHO will provide details of the additional cases involved in this outbreak as well as intervention measures implemented by the MoH. 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 dromedary camels, animal products (for example, consumption of camel’s raw milk), or humans (for example, 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 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, 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-CoV infection; 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.

MERS-CoV appears to cause more severe disease in people with diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, these people should avoid close 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 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.


MERS-CoV cases announced from Wadi al-Dawasir

Saudi MOH

03/02/2019 19-1793
MERS in Riyadh city: 75-year-old male in Riyadh city, Riyadh region Contact with camels: No Case classification: Primary, community acquired Current status: Hospitalized
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﺮﻳﺎض: ﻣﻨﻄﻘﺔ اﻟﺮﻳﺎض ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ اﻟﺮﻳﺎض 75 ﻞﺟر ﻳ ﻎﻠﺒ ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ ﻻ: ﻣﻜﺘﺴﺒﺔ ﻓﻲ اﻟﻤﺠﺘﻤﻊ ، ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا أ:ﺔﻴﻟو ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :مﻮﻨﻣ ﻲﻓ اﻟﻤﺴﺘﺸﻔﻰ
03/02/2019 19-1794
MERS in Wadi Aldwasir city: 55-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: Yes Case classification: Secondary, healthcare-acquired Current status: Hospitalized
ﻣ ﺔﻣزﻼﺘ قﺮﺸﻟا ﻂﺳوﻷا ﺔﻴﺴﻔﻨﺘﻟا ﻦﻣ ﺔﻨﻳﺪﻣ يداو ، ﻋﺎ ًﻣﺎ ﻦﻣ ﺔﻨﻳﺪﻣ يداو اﻟﺪواﺳﺮ 55 اﻟﺪواﺳﺮ: ﻞﺟر ﻳ ﻎﻠﺒ ﺔﻘﻄﻨﻣ اﻟﺮﻳﺎض ﺔﻄﻟﺎﺨﻣ ﻞﺑﻺﻟ :ﻢﻌﻧ ﻣﻜﺘﺴﺒﺔ ﻓﻲ ﻣﻨﺸﺄة ﺔﻴﺤﺻ ، ﻒﻴﻨﺼﺗ ﺔﻟﺎﺤﻟا :ﺔﻳﻮﻧﺎﺛ ﺔﻟﺎﺣ اﻟﻤﺮﻳﺾ :مﻮﻨﻣ ﻲﻓ اﻟﻤﺴﺘﺸﻔﻰ
03/02/2019 19-1795
MERS in Wadi Aldwasir city: 40-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: yes Case classification: Secondary, household contact Current status: Hospitalized


Oman reports one more MERS case, coming just days after it reported four others

AFD

Saudi MOH

03/02/2019 19-1793
MERS in Riyadh city: 75-year-old male in Riyadh city, Riyadh region Contact with camels: No Case classification: Primary, community acquired Current status: Hospitalized

03/02/2019 19-1794
MERS in Wadi Aldwasir city: 55-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: Yes Case classification: Secondary, healthcare-acquired Current status: Hospitalized

03/02/2019 19-1795
MERS in Wadi Aldwasir city: 40-year-old male in Wadi Aldwasir city, Riyadh region Contact with camels: yes Case classification: Secondary, household Current status: Hospitalize


The Saudi Arabian Ministry of Health (MOH) recorded two new cases of MERS in recent days

22/01/2019 19-1783
MERS in Riyadh city: 66-year-old male in Riyadh city, Riyadh region

Contact with camels: No

Case classification: Primary, community acquired

Current status: Hospitalized

“…..The new cases likely lifts on the global total since 2012 to 2,288 cases, at least 806 of them fatal.….”


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