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Middle East respiratory syndrome coronavirus (MERS-CoV) – update (15 May 2014)

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15 MAY 2014 - The following cases of laboratory confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported from Jordan, Lebanon, the Netherlands, the United Arab Emirates, and the United States.

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Jordan

On 11 May 2014, the National IHR Focal Point for Jordan reported to WHO an additional case of MERS-CoV.

The case is a 50 year-old male health-care worker, Jordanian citizen, and resident of Zarka Governorate. He presented with symptoms on 7 May 2014. On 10 May his condition worsened and he was diagnosed with pneumonia after performing a chest X-ray. He was admitted to hospital the same day and tested positive for MERS-CoV. The patient has a history of contact with two MERS-confirmed cases. He is in a stable condition. He is reported to have no history of travel and no history of contact with animals.

Tracing and screening of six family members and 24 health-care workers for MERS-CoV is currently ongoing.

Lebanon

On 8 May, 2014, the National IHR Focal Point (NFP) of Lebanon reported the first laboratory-confirmed case of MERS-CoV infection.

On 22 April 2014, a 60 year-old male health-care worker and national of Lebanon complained of high-grade fever. On 27 April 2014, he was diagnosed with pneumonia and was admitted to the hospital on 30 April 2014. His symptoms included fever, dyspnoea, and productive cough. On 2 May 2014, he tested positive for MERS-CoV. He is reported to have comorbidities. He was in a stable condition in hospital and was released on 7 May 2014.

The patient is reported to have no contact with laboratory confirmed cases or with animals and no history of raw camel milk consumption. No history of travel was reported in the 14 days prior to onset of symptoms.

The patient is known to travel throughout the Gulf region, particularly to Kuwait, Saudi Arabia, and UAE; investigations into the patient’s travel history are ongoing. His most recent travel was five weeks prior to symptom onset to UAE and eight weeks prior to symptom onset to Jeddah where he visited one of the hospitals that had been facing an upsurge of MERS-CoV cases.

Globally, 572 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 173 deaths. The global total includes all of the cases reported in this update (18), plus 58 laboratory confirmed cases officially reported to WHO from Saudi Arabia between 5 and 9 May. WHO is working with Saudi Arabia for additional information on these cases and will provide further updates as soon as possible.

WHO advice

Based on the current situation and available information, WHO encourages all 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 health care facilities. Health-care 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, health-care workers and visitors. Health care 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 health-care 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.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All 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.