Health News - Source Health news WHO

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

Disease outbreak news 22 June 2016

Between 19 and 20 June 2016 the National IHR Focal Point of Saudi Arabia reported six additional cases of Middle East Respiratory Syndrome (MERS).

Four of the newly reported cases are associated with the MERS-CoV Outbreak occurring in a hospital in Riyadh city, Riyadh region (see DON posted 21 June).

Details of the cases

A 34-year-old, non-national, female, working as healthcare worker in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She is asymptomatic and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 20 June. The case has no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

A 31-year-old, non-national, female, working as healthcare worker in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She is asymptomatic and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 20 June. The case has no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

A 58-year-old,* national, male, living in Taif city, Taif region. He developed symptoms on 15 June and was admitted to hospital on 17 June. The patient, who has comorbidities, tested positive for MERS-CoV on 19 June. Investigation of history of exposure to the known risk factors in the 14 days prior to onset of symptoms is ongoing. Currently he is in stable condition admitted to a negative pressure isolation room on a ward.

A 32-year-old, non-national, female, working as healthcare worker in the hospital where the MERS-CoV outbreak is currently occurring and living in Riyadh city, Riyadh region. She has mild symptoms and was identified through the contact tracing of healthcare contacts. The patient, who has a history of caring for the index case, tested positive for MERS-CoV on 19 June. The case has no comorbidities and no history of exposure to the other known risk factors in the 14 days prior to detection. Currently she is in stable condition in home isolation.

A 42-year-old, national, male living in Riyadh city, Riyadh region. He developed symptoms on 16 June. The patient, who has co-morbidities, tested positive for MERS-CoV on 18 June. He is a household contact of a previously reported case (see DON posted 21 June, case no.2). He has no other history of exposure to the known risk factors in the 14 days prior to the onset of symptoms. Currently he is in stable condition in home isolation.

A 44-year-old, national, male living in Najran city, Najran region. He developed symptoms on 4 June and was admitted to hospital on 16 June. The patient, who has no comorbidities but is a smoker, tested positive for MERS-CoV on 18 June. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently the patient is in critical condition admitted to the ICU on mechanical ventilation.

Contact tracing of household and healthcare contacts is ongoing for these cases.
The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 1 MERS-CoV case that was reported in a previous DON on 19 June (case no. 1)
Globally, since September 2012, WHO has been notified of 1,768 laboratory-confirmed cases of infection with MERS-CoV, including at least 630 related deaths.

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 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.
Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.