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Between Dec. 19 and Dec. 30, 2014, the National IHR Focal Point for the Kingdom of Saudi Arabia (KSA) notified the World Health Organization (WHO) of three additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including one death.
Details of the cases are as follows:
1. An 84-year-old male from Najran city developed symptoms on Dec. 26. He was admitted to a hospital on Dec. 28. The patient had comorbidities. He owned goats and sheep but had no history of direct contact with them. The patient resided in an area with heavy presence of camels. He had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient was admitted to the ICU but died on Jan. 1, 2015.
2. A 31-year-old female from Riyadh city developed symptoms on Dec. 20. She was admitted to a hospital on Dec. 23. The patient has comorbidities. She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in the ICU in critical condition.
3. A 53-year-old male from Alkharj city developed symptoms on Dec. 12. He was admitted to a hospital on Dec. 17. The patient has comorbidities. He owns goats and sheep and has frequent contact with them. Despite residing in an area with heavy presence of camels, the patient has no history of contact with them or consuming raw camel products. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition and remains in an isolation ward.
Contact tracing of household contacts and healthcare contacts is ongoing for these cases.
Globally, the WHO has been notified of 944 laboratory-confirmed cases of infection with MERS-CoV, including at least 348 related deaths.
Based on the current situation and available information, WHO encourages all of its 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 handwashing 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.