MOH

Oman

Ministry Confirms a Coronavirus case

2/11/2017

The Ministry of Health confirmed on the 1^st of November 2017 the diagnosis of a new case with the Middle East respiratory syndrome coronavirus (MERS-CoV). The patient is in his twenties and is currently in a stable condition and under medical care in one of the referral hospitals.

The Ministry hence stresses the readiness of all referral hospitals to deal with such cases through the effective applicable epidemiological surveillance system. Moreover, the MOH in collaboration with the relevant authorities proceed carrying out the necessary health measures.

WHO

Between 31 August and 26 September 2017, the national IHR focal point of Saudi Arabia reported nine additional cases of Middle East Respiratory Syndrome (MERS), including four deaths. In addition, four deaths from previously reported cases were reported.

Details of the cases

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

• MERS-CoV cases reported between 31 August and 26 September 2017
  xlsx, 53kb

Among the nine newly reported cases, one was associated with a MERS cluster in Dawmet Aljandal City, Al Jawf region, Saudi Arabia reported previously.

Globally, 2090 laboratory-confirmed cases of infection with MERS-CoV including at least 730 related deaths have been reported to WHO.

Public health response

The source of infection of the cases reported are under investigation by the Ministry of Health and Ministry of Agriculture (when dromedaries are involved) in Saudi Arabia. The Saudi Arabian Ministry of Health has identified and is following up health care workers and household contacts of known MERS patients. As per Saudi Arabian policy, listed contacts were not allowed to attend Hajj.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality. Close direct or indirect contact with infected dromedaries is the main source of primary human infections. MERS-CoV has demonstrated the ability to transmit between humans. So far, human-to-human transmission has occurred mainly in health care settings.

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 animals or animal products (for example, following contact with dromedaries) or human source (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, 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.

Community and household awareness of MERS and MERS prevention measures in the home may reduce household transmission and prevent community clusters.

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, in addition to avoiding close contact with suspected or confirmed human cases of the disease, people with these conditions 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.

Crit Care Med

OBJECTIVES:

To describe patient characteristics, clinical manifestations, disease course including viral replication patterns, and outcomes of critically ill patients with severe acute respiratory infection from the Middle East respiratory syndrome and to compare these features with patients with severe acute respiratory infection due to other etiologies.

DESIGN:

Retrospective cohort study.

SETTING:

Patients admitted to ICUs in 14 Saudi Arabian hospitals.

PATIENTS:

Critically ill patients with laboratory-confirmed Middle East respiratory syndrome severe acute respiratory infection (n = 330) admitted between September 2012 and October 2015 were compared to consecutive critically ill patients with community-acquired severe acute respiratory infection of non-Middle East respiratory syndrome etiology (non-Middle East respiratory syndrome severe acute respiratory infection) (n = 222).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Although Middle East respiratory syndrome severe acute respiratory infection patients were younger than those with non-Middle East respiratory syndrome severe acute respiratory infection (median [quartile 1, quartile 3] 58 yr [44, 69] vs 70 [52, 78]; p < 0.001), clinical presentations and comorbidities overlapped substantially. Patients with Middle East respiratory syndrome severe acute respiratory infection had more severe hypoxemic respiratory failure (PaO2/FIO2: 106 [66, 160] vs 176 [104, 252]; p < 0.001) and more frequent nonrespiratory organ failure (nonrespiratory Sequential Organ Failure Assessment score: 6 [4, 9] vs 5 [3, 7]; p = 0.002), thus required more frequently invasive mechanical ventilation (85.2% vs 73.0%; p < 0.001), oxygen rescue therapies (extracorporeal membrane oxygenation 5.8% vs 0.9%; p = 0.003), vasopressor support (79.4% vs 55.0%; p < 0.001), and renal replacement therapy (48.8% vs 22.1%; p < 0.001). After adjustment for potential confounding factors, Middle East respiratory syndrome was independently associated with death compared to non-Middle East respiratory syndrome severe acute respiratory infection (adjusted odds ratio, 5.87; 95% CI, 4.02-8.56; p < 0.001).

CONCLUSIONS:

Substantial overlap exists in the clinical presentation and comorbidities among patients with Middle East respiratory syndrome severe acute respiratory infection from other etiologies; therefore, a high index of suspicion combined with diagnostic testing is essential component of severe acute respiratory infection investigation for at-risk patients. The lack of distinguishing clinical features, the need to rely on real-time reverse transcription polymerase chain reaction from respiratory samples, variability in viral shedding duration, lack of effective therapy, and high mortality represent substantial clinical challenges and help guide ongoing clinical research efforts.

WHO

Countries agree next steps to combat global health threat MERS-CoV

Critical next steps to accelerate the response to the global public health threat posed by Middle-East respiratory syndrome coronavirus (MERS-CoV) have been agreed by representatives from the Ministries of Health and Ministries of Agriculture of affected and at risk countries, and experts. The virus, which circulates in dromedary camels without causing visible disease, can be fatal for humans.

At a meeting hosted by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE) in Geneva this week, more than 130 experts from 33 countries, organizations and research institutions met to share what is known about the virus, identify priority research needs, improve cross-collaboration between animal and human health sectors and agree on a plan to address crucial gaps.

“MERS is not only a regional threat. While the majority of human cases have been reported from the Middle-East, the outbreak in the Republic of Korea in 2015 showed MERS’ global reach and capacity to have significant public health and economic consequences,” said Dr Maria Van Kerkhove, MERS-CoV Technical Lead in WHO’s Health Emergencies programme. “We are at the stage where we have to confront the challenges in our ability to detect and respond to MERS outbreaks and improve our knowledge about this virus through collaborative research,” she said.

Since 2012, when the virus was first identified in Saudi Arabia, there have been 2081 laboratory-confirmed cases of MERS-CoV infection reported to WHO from 27 countries, with at least 722 deaths – a fatality rate of 35%. While progress has been made in research and surveillance, significant gaps remain in understanding the virus, including how it circulates in dromedary camels, the natural reservoir host, or how it spills over into the human population.

“MERS-CoV is a disease with a significant impact on public health, which requires further investigations in animal sources to better understand its epidemiology and improve its control in humans. OIE Member Countries are requested to notify any occurrences of MERS-CoV in animals. This crucial information will contribute to escalating a coordinated response from the animal and human health sectors”, said Dr Gounalan Pavade, Chargé de mission, OIE.

More than 80% of MERS cases have been reported from Saudi Arabia. While many of these people were infected in health care facilities, with improved data collection on MERS patients since 2015, a significant proportion of recently reported human cases are believed to have been exposed through direct or indirect contact with infected camels. Frequent international travel has allowed sporadic cases to be exported to every region of the world by individuals who are unknowingly infected before they travel.

“It is in our common interest to address the disease in the human-animal interface, work across sectors and disciplines, together for the sake of our shared goals, healthy people and healthy animals” said Dr Ahmed El Idrissi, Senior Animal Health Officer, FAO. “In doing so we recognize the importance of a One Health approach to health threats of animal origin”.

Human to human transmission remains limited, but health-care associated outbreaks have occurred in several countries in the Middle East and in the Republic of Korea. Infection prevention and control measures are vital to prevent the possible spread of the disease in hospitals and clinics and to protect health-care workers, visitors and other patients. No vaccine or specific treatment is currently available and treatment is supportive and based on the patient’s clinical condition.

MERS-CoV is one of the high threat pathogens included in the WHO’s Research & Development Blue Print which provides a road map for research and development of diagnostic, preventive and therapeutic products for prevention, early detection and response to these threats caused by a list of 11 high prioritized pathogens.

The MERS research priorities and activities being guided by WHO, FAO and OIE build on a series of regional and global meetings organized by the three organizations over the past five years. While tremendous progress has been made, particularly at addressing some key unknowns about the behaviour of this virus in animals and humans, some fundamental gaps about MERS-CoV remain. The global community remains within the grip of this emerging infectious disease.

AJIC

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control
Alfaraj, Sarah H. et al.
American Journal of Infection Control

“…..During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV–positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV….”