Global & Disaster Medicine

WHO: Early MERS-CoV identification in the community and in healthcare facilities and compliance with infection prevention and control protocols still pose major challenges


“Between 2012 and 21 July 2017, 2040 laboratory-confirmed cases of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection were reported to WHO, 82% of whom were reported by the Kingdom of Saudi Arabi. 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 underlying conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death. To date, at least 710 individuals have died (crude CFR 34.8%)…….Since the last global update of 5 December 2016, approximately 31% of cases reported to WHO were associated with transmission in a health-care facility. These cases included health-care workers (40 cases), patients sharing rooms/wards with MERS patients, or family visitor……..”

Summary:  “….Summary – information available from 2012 to date
Thus far, no sustained human-to-human transmission has occurred anywhere in the world, however limited nonsustained human-to-human transmission in health-care facilities remains a prominent feature of this virus. WHO continues to work with health authorities in the affected countries. WHO understands that health authorities in affected countries, especially those in the most affected countries, are aggressively investigating cases and contacts, including testing for MERS-CoV among asymptomatic contacts, and applying mitigation measures to stop humanto-human transmission in health-care settings.
Of all laboratory-confirmed cases reported to date (n=2040), the median age is 52 (IQR 36-65; range >1-109 years old) and 66.4% are male.
At the time of reporting, 21.5% of the 2040 cases were reported to have no or mild symptoms, while 46.8% had severe disease or died. Overall, 19.6% of the cases reported to date have been in health-care workers.
Since 2012, 27 countries have reported cases of MERS-CoV infection. In the Middle East: Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, the Kingdom of Saudi Arabia, the United Arab Emirates and Yemen; in Africa: Algeria and Tunisia; in Europe: Austria, France, Germany, Greece, Italy, the Netherlands, Turkey and the United Kingdom; in Asia: China, the Republic of Korea, Malaysia, the Philippines and Thailand; and in the Americas: the United States of America (Table 1).
The majority of cases (approximately 82%) have been reported from Saudi Arabia (Figure 1).
Populations in close contact with dromedaries (e.g. farmers, abattoir workers, shepherds, dromedary owners) and healthcare workers caring for MERS-CoV patients are believed to be at higher risk of infection. Healthy adults tend to have mild subclinical or asymptomatic infections. To date, limited human-to-human transmission has occurred between close contacts of confirmed cases in household settings. More efficient human-to-human transmission occurs in health-care settings due to inadequate and/or incomplete compliance with the infection prevention and control measures and delay in triage or isolation of suspected MERS patients. Health-care-associated transmission has been documented in several countries between 2012-2016, including the Kingdom of Saudi Arabia, Jordan, the United Arab Emirates, France, the United Kingdom, and the Republic of Korea with varying outbreak sizes (2-180 reported cases per outbreak). The largest outbreak outside of the Middle East occurred in the Republic of Korea resulting in 186 cases (including one case who travelled to China) and 38 deaths.

Overall, the reproduction number (R0) of MERS-CoV is <1 with significant heterogeneity in specific contexts. Specifically, outbreaks in health-care settings can have R>1,
but they can be brought under control (R<1) with proper application of infection prevention and control measures and early isolation of subsequent cases. ….”

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