MERS-CoV Update

Virus kills Saudi and UAE healthcare workers

At the time of going to press WHO reports that the most recent laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection include cases in Saudi Arabia, United Arab Emirates, Jordan and Oman. Two of the fatal cases include healthcare workers from the UAE and Saudi Arabia.

Globally, from September 2012 to the time of going to press, 28 February 2014, WHO has been informed of a total of 184 laboratory- confirmed cases of infection with MERSCoV, including 80 deaths.

- On 20 December 2013 a 59-year-old man became sick with fever, cough and shortness of breath in Oman. He was admitted to hospital in North Batinha Governorate on 24 December. On 28 December his condition deteriorated and he was transferred to an intensive care unit and was diagnosed with pneumonia. The patient died on 30 December. Lab tests confirmed MERS-CoV. WHO reports that the patient had a history of daily exposure to camels and other farm animals and also participated in camel race events. In addition, the man was a heavy smoker.

- On 29 December 2013 a 54-year-old man, a healthcare worker from Riyadh, developed respiratory illness symptoms. He was hospitalized on 4 January 2014. The patient received medical treatment in an intensive care unit. He died on 14 January 2014. Samples tested positive for MERS-CoV after his death. The patient was a healthcare worker. He had a history of chronic disease and had no history of contact with animals or contact with known cases of MERS-CoV. In addition, he had no travel history. WHO reported the investigation was ongoing.

- On 31 December 2013 a 48-year-old man from Jordan became ill and developed fever, dry cough, difficulty in breathing, abdominal pain and vomiting. He was admitted to a hospital on 9 January 2014. While there, his condition worsened and on 16 January he was placed on mechanical ventilation. The patient died on 23 January. A sample taken from the patient on 21 January tested positive for MERS-CoV. WHO reports that the patient had underlying health conditions and had travelled to the United Kingdom from 12 November to 25 December 2013 seeking treatment for his underlying conditions. The patient had no history of animal contact and is believed to have not attended any large social events in the previous 30 days. It is reported that he had received 2 guests from Kuwait between 25 December and 31 December, 2013. Further investigations are ongoing in Jordan and UK.

- On 19 January 2014 a 60-year-old man from Riyadh became ill. He had underlying medical conditions. He was hospitalized on 24 January and died on 28 January. Respiratory specimens confirmed MERS-CoV. Details of his possible contact with animals are unknown, and he has no history of contact with a laboratory-confirmed case.

- Among the six new cases reported from UAE, three were from one family in Abu Dhabi, including a 32-year-old pregnant woman who died on 2 December 2013. Before her death, the woman gave birth to a healthy baby, who had no evidence of MERS-CoV infection.

- One of the recent cases from UAE was a 33-year-old healthcare worker who provided direct care for a 68-year-old patient with laboratory-confirmed MERS-CoV infection. The healthcare worker subsequently developed severe disease requiring mechanical ventilation and haemodialysis. The healthcare worker died on 16 January 2014. The 68-year-old patient, a Dubai man, also subsequently died.

- On 23 January 67-year-old man from Riyadh became ill. He was hospitalised on 25 January. The patient had an underlying medical condition. He had no reported history of contact with animals or with a previously laboratory-confirmed case.

- On 3 February a 22-year-old man from Saudi Arabia’s Eastern Region became ill. He was hospitalised on 9 February and died on 12 February 2014. The patient had an underlying medical condition. He had no reported history of contact with animals or a previously laboratory-confirmed case.

WHO recommendations

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

The WHO advises that as MERS-CoV infections may be acquired in healthcare facilities there is a need to continue to strengthen infection prevention and control measures. Healthcare facilities that provide care for patients suspected or confirmed with MERSCoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, healthcare workers and visitors. Education and training for infection prevention and control should be provided to all healthcare workers and regularly refreshed.

Early identification of the MERS-CoV is important, but not all the cases could be reliably and timely detected, especially when disease is mild or presents atypically. Therefore, it is important to ensure that standard precautions are consistently used for all patients and all work practices all of the time, regardless of suspected or confirmed infection with the MERS-CoV or any other pathogen. Droplet precautions should be added when providing care to all patients with symptoms of acute respiratory infection, and contact precautions plus eye protection should be added when caring for confirmed or probable cases of MERS-CoV infection. Airborne precautions are indicated when performing aerosol generating procedures.

When the clinical and epidemiological clues strongly suggest MERS-CoV, the patient should be managed as potentially infected, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

 Date of upload: 09th Apr 2014


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