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The Ministries of Health of Saudi Arabia and the United Arab Emirates (UAE) recently announced additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).
The four additional laboratory-confirmed cases reported to WHO by the Ministry of Health of Saudi Arabia on March 28 and April 2, 2014 include:
A 26-year-old man from Jeddah became ill on March 22, was hospitalized on March 23, and died on April 6.
A 26-year-old man from Jeddah became ill on March 16 and has been hospitalized since March 25.
A 77-year-old woman from Riyadh region became ill on March 25 and is currently in stable condition. She is not known to have a history of exposure to animals.
A 59-year-old man from Riyadh region became ill on March, 22. He is not known to have contact with animals or a known case.
The additional laboratory-confirmed case reported to WHO by the Ministry of Health of the UAE on March 30 includes:
A 64 year-old man from Abu Dhabi with underlying medical conditions became ill on March 21, was hospitalized on March 25 and died on March 30. He had underlying medical conditions. He did not have contact with a previously laboratory-confirmed case, but has had exposure to animals. The patient visited a camel farm in Harb city in Saudi Arabia on March 10 and visited Nezwa city in Oman for a day on March 20. He owned an animal farm in the UAE with poultry and sheep, but had no recent visit to the farm. Investigation into the family and health care contacts is ongoing.
Globally, from September 2012 to date, WHO has been informed of a total of 211 laboratory-confirmed cases of infection with MERS-CoV, including 88 deaths.
Based on the current situation and available information, WHO encourages all of its member states to continue their surveillance for severe acute respiratory infections (SARI) 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. Healthcare facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, healthcare workers and visitors. Healthcare workers should be educated, trained and refreshed with skills on infection prevention and control.
It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that healthcare workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.
Droplet precautions should be added to the standard precautions when providing care to all 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.
Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.
Healthcare providers are advised to maintain vigilance. Recent travelers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All WHO member states are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular handwashing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.
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.