MIDDLE EAST RESPIRATORY
SYNDROME (MERS)
·
Abstract: Middle
East respiratory syndrome (MERS) is a viral respiratory disease caused by a
novel coronavirus (MERS‐CoV)
that was first identified in Saudi Arabia in 2012. Coronaviruses are a large
family of viruses that can cause diseases ranging from the common cold to
Severe Acute Respiratory Syndrome (SARS). Typical MERS symptoms include fever,
cough and shortness of breath. Pneumonia is common, but not always present.
Gastrointestinal symptoms, including diarrhoea, have also been reported. Approximately
36% of reported patients with MERS have died. Although the majority of human
cases of MERS have been attributed to human-to-human infections, camels are
likely to be a major reservoir host for MERS-CoV and an animal source of MERS
infection in humans. However, the exact role of camels in transmission of the
virus and the exact route(s) of transmission are unknown. The virus does not
seem to pass easily from person to person unless there is close contact, such
as occurs when providing unprotected care to a patient.
Key
words: MERS Cov, viruses, pneumonia, respiratory
distress, Darwinism and transmission
Introduction:
The Middle East respiratory syndrome
coronavirus (MERS-CoV), is a novel positive-sense,
single-stranded RNA virus of the genus Betacoronavirus. It
was first reported in 2012 after genome sequencing of a virus isolated from
sputum samples from a person who fell ill in a 2012 outbreak of a new flu.
MERS-CoV genomes are phylogenetically classified into two clades, clade A and B. The earliest cases of MERS were of
clade A clusters (EMC/2012 and Jordan-N3/2012), and new cases are genetically
distinct (clade B). As of July 2015, MERS-CoV cases have been reported in over
21 countries, including Saudi Arabia, Jordan, Qatar, Egypt, the United Arab Emirates, Kuwait, Turkey,
Oman, Algeria, Bangladesh, Indonesia (none were confirmed), Austria, the United
Kingdom, South Korea the United States,[5][6] Mainland China, Thailand, and the
Philippines.
Outset:
The first confirmed case was reported in
Saudi Arabia 2012. A second case was found in September 2012, a 49-year-old
male living in Qatar presented with similar flu symptoms, and a sequence of the
virus was nearly identical to that of the first case.
Dispatch:
On 13 February 2013, the World Health Organization stated "the risk of sustained
person-to-person transmission appears to be very low. The Centers for Disease Control and
Prevention (CDC) list MERS as transmissible from
human-to-human.
1. Non-human to human transmission: The route of transmission from
animals to humans is not fully understood, but camels are likely to be a major
reservoir host for MERS-CoV and an animal source of infection in humans.
Strains of MERS-CoV that are identical to human strains have been isolated from
camels in several countries, including Egypt, Oman, Qatar, and Saudi Arabia.
2. Human-to-human transmission: The virus does not appear to pass
easily from person to person unless there is close contact, such as providing
unprotected care to an infected patient. There have been clusters of cases in
healthcare facilities, where human-to-human transmission appears to be more
probable, especially when infection prevention and control practices are
inadequate. Thus far, no sustained community transmission has been documented.
Darwinism:
The evidence available to date suggests
that the viruses have been present in bats for some time and had spread to
camels by the mid 1990s. The viruses appear to have spread from camels to
humans in the early 2010s. The original bat host species and the time of
initial infection in this species have yet to be determined.
People at increased Risk:
1.
People with co-morbid
condition included diabetes; cancer; and chronic lung, heart, and kidney
disease and weakened immune systems.
2.
Recent Travellers from the
Arabian Peninsula
3.
Close Contacts of an Ill Traveller
from the Arabian Peninsula
4.
Close Contacts of a
Confirmed Case of MERS
5.
Healthcare Personnel Not
Using Recommended Infection-Control Precautions
6.
People with Exposure to
Camels
The
incubation period for MERS: Are usually about 5 or 6
days, but can range from 2-14 days.
Symptoms:
Common symptoms are severe acute respiratory
illness with symptoms of: fever, cough and shortness of breath. Some people also had gastrointestinal
symptoms including diarrhea and nausea/vomiting.
Treatment and Prevention:
·
There
is no vaccine or specific treatment is available at present. Only supportive
treatment is available based on the clinical symptoms.
·
As
a general precaution, anyone visiting farms, markets, barns, or other places
where camels and other animals are present should practice general hygiene
measures, including regular hand washing before and after touching animals, and
should avoid contact with sick animals.
·
The
consumption of raw or undercooked animal products, including milk and meat,
carries a high risk of infection from a variety of organisms that might cause
disease in humans. Animal products that are processed appropriately through
cooking or pasteurization are safe for consumption, but should also be handled
with care to avoid cross contamination with uncooked foods. Camel meat and
camel milk are nutritious products that can continue to be consumed after
pasteurization, cooking, or other heat treatments.
·
People
at increase risk should avoid contact with camels, drinking raw camel milk or
camel urine, or eating meat that has not been properly cooked.
·
Appropriate
measures to decrease the risk of transmission of the virus from an infected patient
to other patients, health‐care workers, or visitors. Health‐care workers should be educated and trained in infection
prevention and control and should refresh these skills regularly.
Complication:
Pneumonia and kidney failure.
Prognosis:
About 3-4 out of
every 10 people reported with MERS have died.
Most of the people
who died had an underlying medical condition. Some infected people had mild
symptoms (such as cold-like symptoms) or no symptoms at all; they recovered.
Pneumonia
due to MERS CoV is associated with a high rate of mortality that reached 76%.
Role of CDC in controlling MERS CoV:
1.
continued to collaborate with international
partners on epidemiologic and laboratory studies to better understand MERS
2. Improved
the way to collect data about MERS cases
3. Increased
lab testing capacity in states to detect cases
4. Developed
guidance and tools for health departments to conduct public health
investigations when MERS cases are suspected or confirmed
5. Provided
recommendations for healthcare infection control and other measures to prevent
disease spread
6. Provided
guidance for flight crews, Emergency Medical Service (EMS) units at airports,
and U.S. Customs and Border Protection (CPB) officers about reporting ill travellers
to CDC
7. Disseminated
up-to-date information to the general public, international travellers, and
public health partners
8. Used
Advanced Molecular Detection (AMD) methods to sequence the complete virus
genome on specimens from cases to help evaluate and further describe the
characteristics of MERS-CoV.
Role of WHO in
controlling MERS CoV:
1.
WHO
is working with clinicians and scientists in affected countries and
internationally to gather and share scientific evidence to better understand of
the disease?.
2.
Working
with countries to develop public health prevention strategies to combat the
virus.
3.
WHO
is coordinating the global health response to MERS, including: the provision of
updated information on the situation; conducting risk assessments and joint
investigations with national authorities; convening scientific meetings; and
developing guidance and training for health authorities and technical health
agencies on interim surveillance recommendations, laboratory testing of cases,
infection prevention and control, and clinical management
4.
.
WHO continues to request that Member States report to WHO all confirmed and
probable cases of infection with MERS-CoV together with information about their
exposure, testing, and clinical course to inform the most effective
international preparedness and response.
Discussion:
Transmission of MERS CoV
between patients to health care worker also reposted. It is not easy to
diagnose this condition as early as possible as the symptoms are life flu and
non specific. Prevention and spread control measure are only effective method
to prevent the possible spread of MERS CoV in general public as well as in
health care facility. Positive case of MERS CoV is not reported .in India yet,
but the symptoms of swine flu and MERS Cov looks similar. HINI virus which causes swine flu also
derived form same group of virus. It is expected to follow prevention and
control measure that we follow for influenza A (H1N1) to be free from MERS CoV
in India even in the feature.
Reference:
