Middle East respiratory syndrome (MERS) is a respiratory disease caused by a coronavirus (MERS CoV)

What is the source of this virus (MERS-CoV)?

The exact source of MERS�CoV is not known. It was first reported in Saudi Arabia in 2012. MERS-CoV has been found in camels in Qatar, Oman, Egypt and Saudi Arabia, and a bat in Saudi Arabia. Camels in few other countries have also been tested positive for antibodies to MERS-CoV, indicating that the camels were previously infected with this virus . Humans possibly got infected from camels.
 

Which countries are affected so far?

The following countries have reported cases of MERS: Jordan, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen (Middle East); France, Germany, Greece, Italy, and the United Kingdom (Europe); Tunisia and Egypt (Africa); Malaysia and the Philippines (Asia); and the United States of America .

Is MERS contagious?

Yes, But virus does not pass easily from one person to another unless there is close contact and infection prevention and control measures are inadequate.

What is Incubation Period:?

The incubation period is between 9 and 12-days. In majority of cases it is less than a week although it may exceed one week but is less than two weeks.

How can people get infected with MERS?

Infected person can spread virus to close contacts which includes health care workers , family members and any other person who was exposed to that patient during incubation period. In few cases source of infection was not found.
 

Disease is mostly affecting old age as the median age of cases is 51 years (Range 14 months to 94 years).Males are predominant among reported cases (65%) as well as deaths. Persons with co-morbidities like liver ,heart or kidney diseases , Diabetics and immune - compromised patients are more at risk as compare to health individuals.

What are the symptoms of MERS?

It can present as fever, cough, shortness of breath and Pneumonia.  Gastrointestinal symptoms, like diarrhea, have also been reported. The virus appears to cause more severe disease in people with weakened immune systems, older people, and those with such chronic diseases as diabetes, cancer, and chronic lung disease.  Severe illness can cause ARDS &respiratory failure that might need mechanical ventilation.

What is the treatment?

Treatment is supportive and based on the patient�s clinical condition. Steroids should be avoided. Currently no vaccine or anti Viral therapy is available.

What is Mortality rate of MERS?

It is around 27 � 30%. In some people, infection did not cause any symptoms. Such persons have been found because they were tested for MERS-CoV during follow‐up studies of contacts of people with MERS infection.

What should I do if I had close contact with someone who has recently travelled to Arabian Peninsula.?

 If you have had close contact within 14 days of person�s travel from a country in the Arabian Peninsula and the traveler is confirmed or suspected case of MERS, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person. If you develop respiratory illness, you should see your doctor. While sick, try to stay at home to reduce the possibility of spreading illness to others.

 Who should be tested for MERS?

Any one who develops  fever, cough or shortness of breath, within 14 days after travel from a country in or near the Arabian Peninsula or if have had close contact with suspected or confirmed case of MERS, or has respiratory illness like pneumonia or ARDS which is not explained by any other cause should be tested for MERS-CoV

 What kind of Tests are available?

�  Two types of tests are available

�   RT-PCR(Real time polymerase chain reaction)�Detects Viral RNA

If it detects viral RNA it means person has active infection with MERS-CoV. Lower respiratory specimens (sputum, bronchoalveolar lavage, endotracheal aspirates) are a preferred respiratory specimen for RT-PCR testing. Nasopharyngeal and Oropharyngeal specimens can be collected. If initial testing of a nasopharyngeal swab is negative in a patient who is strongly suspected to have MERS-CoV infection, patients should be retested using a lower respiratory specimen or a repeat nasopharyngeal specimen

�  Serology �Detects antibodies against virus

Blood samples are collected to detect antibodies against MERS-CoV that would indicate a person had been previously infected with the virus and developed an immune response.

Sample Collection and Transportation in Pakistan

According to ministry of health Pakistan

• Specimens being sent for MERS-CoV testing should preferably be tested at local facility to exclude the presence of other known respiratory pathogens before dispatch.

• Exercising standard, contact, droplet and airborne precautions, samples must be transported to NIH; duly labeled / packed in triple packaging to the Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad along with detailed clinical information and travel / contact history.

• For any likely delay in reaching referral laboratory, the respiratory tract specimens or serum may be frozen on dry ice.

Is it safe to travel to the Middle East / perform Umerah or Hajj ?

WHO does not recommend the application of any travel or trade restrictions or entry screening related to MERS-CoV.

The Kingdom Saudi Arabia on 13^thJul 2013, recommended to postpone the Umrah and Hajj last year for elderly and those suffering from chronic illnesses, like heart, kidney, respiratory diseases, diabetes and people with immune deficiency, as well as children and pregnant women.

What Standard Precautions are recommended ?

Although the source of the virus and the mechanism of transmission is not clearly understood , we should try to reduce the general risk of infection by:

• Avoiding direct contact with ill persons, and wear masks in crowded locations, maintaining personal hygiene as a whole.N95 masks are recommended for health workers.

• Washing hands thoroughly with soap and water or disinfectant, especially after coughing and sneezing, and cover while coughing or sneezing; dispose of the waste in a basket; do not touch your eyes, nose, or mouth with your hands

• Adhering to food safety and hygiene rules such as avoiding undercooked meats, raw fruits and vegetables unless they have been peeled, or unsafe water.

• Clean and disinfect frequently touched surfaces such as toys and doorknobs

• Avoiding close contact with live farm or wild animals.

• Seeking immediate medical attention in case of sickness

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Ameer-ud-Din Medical College

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