The South East Asia Region (SEAR) of the World Health Organization (WHO) has confirmed a case of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Thailand. The individual is a traveler from the Middle East region.
The WHO has advised countries in the SEAR to enhance preparedness for MERS-CoV.
Introduction/ Background
Coronaviruses are a large family of viruses that can cause mild (common cold) to severe diseases (Severe Acute Respiratory Syndrome [SARS]).
Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a new coronavirus (MERS-CoV) that was first identified in Saudi Arabia (2012).
Camels are likely to be a major reservoir host for MERS-CoV, and an animal source of MERS infection in humans. However, the exact role of camels in virus transmission is unknown.
Some refer to the MERS-CoV as ‘camel virus’.
The Virus
MERS-CoV is a zoonotic virus (animal virus) that is transmitted from animals to humans.
It is believed to have originated in bats, and transmitted to camels sometime in the distant past.
The virus appears to be circulating in the Arabian Peninsula, primarily in Saudi Arabia (>85% of cases have been reported from there since 2012).
Transmission
Human-to-Human transmission: Occurs when there is unprotected close contact, such as providing unprotected care to a patient. Clusters of cases have occurred in healthcare facilities with inadequate infection prevention and control practices.
No sustained community transmission has been documented till date.
Most cases reported outside the Middle East are believed to have been acquired in the Middle East, then exported outside the region.
Non-Human to Human transmission: The transmission route(s) from animals to humans are not fully understood. Camels are likely to be a major reservoir host for MERS-CoV and an animal source of infection in humans.
Clinical Features (Symptoms and Signs)
The infection spectrum ranges from asymptomatic (no symptoms) to severe acute respiratory disease and death.
Typically, patients develop fever, cough and breathlessness.
Pneumonia is often, but not always present.
Diarrhoea may be present.
Severe illness can cause respiratory failure that requires intensive care treatment (mechanical ventilation and supportive care).
Case Fatality Rate
About 36% of reported patients with MERS-CoV have died.
Risk Factors for severe disease
Elderly
Those with weakened immune systems- immunocompromised persons
Those with chronic diseases- cancer, chronic lung disease, diabetes, renal failure
Treatment
There is no specific treatment for MERS-CoV infection.
Treatment is supportive and based on the patient’s clinical condition.
Prevention
There is no vaccine against MERS-CoV infection.
Precautions:
Regular hand washing before and after touching camels/other animals.
Avoid contact with sick animals.
Avoid consumption of undercooked/ un-pasteurized animal products.
Animal products- meat/milk, etc.- that are processed appropriately through cooking/ pasteurization are safe for consumption.
Prevent cross-contamination of cooked foods with raw foods.
Those at high risk for severe disease should avoid contact with camels, drinking raw camel milk/ urine, or eating meat that has not been properly cooked.
Health-care facilities
Facilities that provide care for patients suspected/ confirmed to be infected with MERS-CoV should take appropriate measures to decrease the risk of transmission from an infected patient to other patients, health-care workers, or visitors.
Health-care workers should be educated and trained in infection prevention and control. They should refresh these skills regularly.
Travel
The WHO does not recommend the application of any travel or trade restrictions, or entry screening related to MERS-CoV.
Useful Links:
Link to the WHO factsheet on MERS-CoV (updated 7 June 2015):
http://www.who.int/mediacentre/factsheets/mers-cov/en/
Link to the press release from WHO SEARO (dated 18 June 2015):
http://www.searo.who.int/mediacentre/releases/2015/1605/en/
Link to the Disease outbreak news regarding MERS-CoV:
Saudi Arabia (16 June 2015)
http://www.who.int/csr/don/16-june-2015-mers-saudi-arabia/en/
South Korea (19 June 2015)
http://www.who.int/csr/don/19-june-2015-mers-korea/en/
Thailand (20 June 2015)
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