The World Health Organization (WHO) has been notified of two additional laboratory-confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV).
WHO was notified of one case by the Ministry of Health of Saudi Arabia. The case is a 54-year-old man from Riyadh who developed respiratory illness symptoms on Dec. 29, 2013 and was hospitalized on Jan. 4, 2014. The patient received medical treatment in an intensive care unit. He died on Jan. 14, 2014. Samples tested positive for MERS-CoV after his death. The patient was a healthcare worker. He had a history of chronic disease and had no history of contacts with animals or contact with known cases of MERS-CoV. In addition, he had no travel history. The investigation is ongoing.
WHO was notified of one case by the Ministry of Health of Jordan on Jan. 23, 2014. The case is a 48-year-old man who became ill on Dec. 31, 2013 and developed fever, dry cough, difficulty in breathing, abdominal pain and vomiting, and was admitted to a hospital on Jan. 9, 2014. While there, his condition worsened and on Jan. 16 he was placed on mechanical ventilation. The patient died on Janu. 23. A sample taken from the patient on Jan. 21 tested positive by PCR for MERS-CoV. The patient had underlying health conditions and he had travelled to the United Kingdom from Nov. 12, 2013 to Dec. 25, 2013 seeking treatment for his underlying conditions. The patient had no history of animal contact and is believed to have not attended any large social events in the last 30 days. It is reported that he had received two guests from Kuwait between Dec. 25 and Dec. 31, 2013.Â National authorities in Jordan are following family contacts, medical staff and healthcare workers, in addition to strictly applying infection control measures. Further investigations are ongoing in Jordan and UK.
Globally, from September 2012 to date, WHO has been informed of a total of 180 laboratory-confirmed cases of infection with MERS-CoV, including 77 deaths.
MERS-CoV infections that may be acquired in healthcare facilities illustrate the need to continue to strengthen infection prevention and control measures. Healthcare facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, healthcare workers and visitors. Education and training for infection prevention and control should be provided to all healthcare workers and regularly refreshed.
Early identification of the MERS-CoV is important, but not all the cases could be reliably and timely detected, especially when disease is mild or presents atypically. Therefore, it is important to ensure that standard precautions are consistently used for all patients and all work practices all of the time, regardless of suspected or confirmed infection with the MERS-CoV or any other pathogen. Droplet precautions should be added when providing care to all patients with symptoms of acute respiratory infection, and contact precautions plus eye protection should be added when caring for confirmed or probable cases of MERS-CoV infection. Airborne precautions are indicated when performing aerosol generating procedures.
When the clinical and epidemiological clues strongly suggest MERS-CoV, the patient should be managed as potentially infected, 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.
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.