Between Oct. 12 and Oct. 16, 2014, the National IHR Focal Point for the Kingdom of Saudi Arabia (KSA) notified the World Health Organization (WHO) of five additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths.
Details of the cases are as follows:
A 42-year-old female nurse from Taif city developed symptoms on Oct. 13. She was admitted to a hospital on Oct. 14. The patient was exposed to a laboratory-confirmed case of MERS-CoV. She has comorbidities but no history of contact with camels or raw camel products consumption. Also, she has no history of travel in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition and under isolation.
A 60-year-old male from Taif city developed symptoms on Oct. 14. On the same day, he was admitted to a hospital. The patient had comorbidities. On Oct. 8, he had received dialysis in the same room used to dialyze a laboratory-confirmed MERS-CoV. He had no history of contact with camels or raw camel products consumption. He also had no history of travel in the 14 days prior to the onset of symptoms. The patient died on Oct. 15.
An 82-year-old male from Hawtah Bani Tamim city developed symptoms on Oct. 3. On Oct. 5 he visited a hospital in Alkharj city, where he stayed for six days. Then, he drove to Riyadh, where he was admitted to a hospital on Oct. 11. The patient has comorbidities. He has had no contact with animals but resides in an area with heavy presence of camel farms. In addition, the patient has a history of raw camel milk consumption in the 14 days prior the onset of symptoms. He has no history of travel in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition.
A 44-year-old male from Riyadh city developed symptoms on Oct. 7. He was admitted to a hospital in Riyadh on Oct. 11. The patient has comorbidities. He has frequent contact with animals but he has no history of contact with camels or consumption of raw camel products in the 14 days prior to the onset of symptoms. The patient travelled to Dammam city in the 14 days that preceded the onset of symptoms. Currently, he is in the ICU.
A 70-year-old male from Al Huwaya town developed symptoms on Oct. 8. He was admitted to a hospital in Taif city on Oct. 10. The patient had comorbidities. The patient had contact with animals but he had no history of contact with camels or consumption of raw camel products in the 14 days prior to the onset of symptoms. Also, he had no history of travel in the 14 days prior to the onset of symptoms. The patient was in critical conditions and admitted to the Intensive Care Unit (ICU) but died on Oct. 28.
Contact tracing of household contacts and healthcare contacts is ongoing for these cases.
Globally, WHO has been notified of 909 laboratory-confirmed cases of infection with MERS-CoV, including at least 331 related deaths.
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 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 non-specific. 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.
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 MERSCoV 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.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.