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On March 18, 2014, the World Health Organization (WHO) was notified of an additional two laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV). One case was notified by the National IHR Focal Point of Kuwait and the other by the National IHR Focal Point of the United Arab Emirates (UAE).
Details of the case notified from Kuwait are as follows:
A 60-year-old Syrian national who was admitted to a hospital in Kuwait on February 13 died on March 6. He had underlying health conditions. The patient was confirmed with MERS-CoV on 9 March. All close contacts of the patients are being followed up.
Details of the case notified from the UAE are as follows:
A 68-year-old man from Abu Dhabi with underlying health conditions became ill on March 7, was admitted to a hospital on March 11 with injury to his finger. He has mild symptoms. The patient was laboratory-confirmed with MERS-CoV on March 17. The patient returned from Saudi Arabia five days prior to his admission in the hospital. He frequently visits Saudi Arabia where he owns a camel farm. Public health authorities are carrying out contact tracing and epidemiological investigations.
Globally, from September 2012 to date, WHO has been informed of a total of 198 laboratory-confirmed cases of infection with MERS-CoV, including 84 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 hand washing 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.