MERS-CoV Update

More deaths in Saudi

In the latest update on MERS-CoV from WHO, before going to press, the organisation stated that between 1 and 15 April 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 10 additional cases of Middle East respiratory syndrome coronavirus (MERSCoV) infection, including 3 deaths.

Contact tracing of household and healthcare contacts was ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 MERS-CoV cases that were reported in an earlier WHO update on 14 April.

Globally, since September 2012, WHO has been notified of 1,724 laboratory-confirmed cases of infection with MERS-CoV, including at least 623 related deaths.

Risk assessment
WHO warns that MERS-CoV causes severe human infections resulting in high mortality and has demonstrated the ability to transmit between humans. So far, the observed human-to-human transmission has occurred mainly in healthcare settings.

WHO notes that based on the current situation and available information, all Member States are encouraged 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 healthcare 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 nonspecific. 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.

High risk
Until more is understood about MERSCoV, 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.

Inadequate infection control

The largest outbreak of Middle East respiratory syndrome (MERS) outside the Middle East occurred in South Korea in 2015 and resulted in 186 laboratory-confirmed infections, including 36 deaths. Some hospitals were considered epicentres of infection and voluntarily shut down most of their operations after nearly half of all transmissions occurred in hospital settings. However, the ways that MERS-coronavirus (MERSCoV) is transmitted in healthcare settings are not well understood.

A recent Korean study published in Clinical Infectious Diseases explored the possible contribution of contaminated hospital air and surfaces to MERS transmission and found evidence for extensive viable MERS-CoV contamination of the air and surrounding materials in MERS outbreak units in a Korean hospital.

The researchers found MERS-CoV in viral cultures of four out of seven air samples as well as 15 of 68 surface swaps. The researchers say there needs to be further study of the possible scenarios for contact and airborne transmission of MERS-CoV and say their study raises “concern regarding the adequacy of current infection control procedures”.

  • doi: 10.1093/cid/ciw239)

King Fahd General Hospital
Another recent study – published in Emerging Infectious Diseases – of a MERS outbreak in Jeddah’s King Fahd General Hospital found that the outbreak – during March-May 2014 that infected many persons who worked or received medical treatment at the hospital – was largely due to “infection control deficiencies included limited separation of suspected MERS patients, patient crowding, and inconsistent use of infection control precautions”.

The researchers note: “Continued vigilance and strict application of infection control precautions are necessary to prevent future MERS outbreaks.”

  • doi: 10.3201/eid2205.151797

Date of upload: 15th May 2016


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