WHO

Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman

On 30 August 2017, the national IHR focal point of Oman reported one case of Middle East respiratory syndrome Coronavirus (MERS-CoV). The last report of MERS-CoV from Oman was on 29 November 2016.

Details of the case

Detailed information concerning the case, a 54-year-old male living in Al Musanaa Batinah region, reported to WHO can be found in a separate document

Globally, 2080 laboratory-confirmed cases of infection with MERS-CoV including at least 722 related deaths have been reported to WHO.

Public health response

The Ministry of Health in Oman is conducting contact tracing and follow-up of family and health care workers at the hospitals where the patient was treated. Laboratory testing for symptomatic and high-risk family contacts, including health care workers is underway. Community members and those who have been in contact with the patient are being educated on infection prevention, mass gatherings, travel, and other related topics, following Oman MERS-CoV National Preparedness and Response Guidelines.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality. Close direct or indirect contact with infected dromedaries is the source of 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.

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.

WHO

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

Between 4 July and 12 August 2017, the national IHR Focal Point of Saudi Arabia reported 26 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection including six deaths, and two deaths among previously reported cases.

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 4 July and 12 August 2017.
  xlsx, 45kb

Among the 26 newly reported cases, 13 are associated with a cluster in a hospital in Al Jawf Region, Saudi Arabia. The initial case was a 51-year-old reported on 2 August 2017. To date, 12 cases have been identified through contact tracing. These cases include eight health care workers (all asymptomatic) in the hospital where the initial case was treated, one hospital contact (a 70-year-old male) and three household contacts. Follow up of health care workers, hospital and household contacts are ongoing.

Globally, 2066 laboratory-confirmed cases of infection with MERS-CoV including at least 720 related deaths have been reported to WHO.

Public health response

The Ministry of Health of Saudi Arabia evaluates each case and their contacts and implements measures to limit further human-to-human transmission and bring Middle East Respiratory Syndrome (MERS) outbreaks under control. The measures taken by Ministry of Health officials in Saudi Arabia include:

• Risk stratification and active tracing for contacts in healthcare and in communities. High risk contacts (e.g. unprotected exposure to a case or engagement in an aerosol generating procedure) are tested by PCR regardless of having symptoms. Health care workers are exempted from work until they are cleared by infection control experts.
• Trained hospital epidemiologists have been deployed to sites within 24 hours of identifying an outbreak.
• Enforcement of strict adherence to environmental disinfection and terminal cleaning of affected areas.
• Enforcement of visual triage for respiratory diseases in emergency department and outpatient departments and ensuring the 24/7 availability of trained nurses for early detection of patients with respiratory symptoms, and proper documentation on triage forms.
• Extensive training of all health care workers on case definition for early detection, implementation of isolation precautions, proper selection, donning and doffing of personal protective equipment (PPE), hand hygiene and environmental cleaning and disinfection.
• Ensuring availability of infection prevention supplies including hand sanitizer, PPEs, surface disinfectants, portable HEPA filters and fumigation machines.
• Ensuring that all health care workers are fit tested for high efficiency respirators.
• Implementing the policy of not allowing health care personnel working in a facility affected by an outbreak to travel or work in Hajj premises or in any healthcare facility until they are medical cleared.

WHO risk assessment

MERS-CoV causes severe human infections resulting in high mortality and 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.

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.

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.

WHO

“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. ….”

International Journal of Infectious Diseases

Abstract

Background