In the News / Politics:

Middle East Respiratory Syndrome (MERS)

By: Uzma Toppa, PharmD Candidate c/o 2014

Middle East Respiratory Syndrome, also known as MERS, is a viral respiratory illness caused by a coronavirus called MERS-CoV. It was first reported in humans in Saudi Arabia in 2012. According to the World Health Organization (WHO), from September 2012 to September 2013, there have been a total of 130 laboratory confirmed cases of infection with MERS-CoV, including 58 deaths, in eight countries.1 A breakdown is seen in Table 1. All cases have been linked, either directly or indirectly, through travel or residence in Saudi Arabia, Qatar, Jordan, and the United Arab Emirates. The virus was first identified in samples obtained from a Saudi Arabian businessman who died from acute respiratory failure.1

Table 1. Number of cases and deaths associated with MERS2

Country

Cases

Deaths

France

2

1

Italy

1

0

Jordan

2

2

Qatar

5

3

Saudi Arabia

108

47

Tunisia

3

1

United Kingdom

3

2

United Arab Emirates

6

2

Total

130

58

The virus spreads through close contact, but the exact mechanism is unknown. The Centers for Disease Control (CDC) is still trying to better understand how the virus spreads, the risks associated with it, and how to prevent it. According to scientists in a new study published in The Lancet, the Middle East respiratory syndrome is most likely transmitted from animals to humans.3 Researchers used DNA analysis to analyze the MERS-CoV genomes from 21 patients infected with MERS throughout Saudi Arabia. Their findings showed that the virus has been transmitted from an animal reservoir to humans and identified camels as possible carriers of the virus.3 Further research is still being conducted.

Saudi Arabia is visited by millions of people a year, especially Muslims carrying out their pilgrimages of Umrah and Hajj. This is something to consider especially now after 3 million people from around the world will be returning home after visiting Mecca, the holy city of Saudi Arabia, for the annual Hajj pilgrimage.4 Thousands of Muslims continue to visit Mecca throughout the year for Umrah. The CDC does not recommend that travel plans be canceled because of MERS but does encourage special populations, such as children under the age of 12, elderly over the age of 65, pregnant women, and persons with chronic diseases or weakened immune systems, postpone their pilgrimage this year.2 The CDC and WHO have issued travel information in order to protect those who do choose to travel.2,5 It is important for countries to make this information available to all people including travelers and public health officials.

Most patients infected with MERS experienced fever, cough, and shortness of breath. Gastrointestinal symptoms, such as diarrhea and vomiting, were also seen. CDC recommends that patients be evaluated for MERS if they develop pneumonia or acute respiratory distress requiring hospitalization within 14 days after traveling to the Arabian Peninsula or coming into close contact with a recent traveler from the area who has fever and acute respiratory illness.1,2,5

The CDC recommends that U.S. travelers to countries in the Arabian Peninsula or neighboring countries* protect themselves by washing their hands often, especially after coughing and sneezing, and trying to avoid contact with people who are sick.2,4,5 People are also recommended not to touch their eyes, nose, or mouth while in public places to avoid transmission of the disease. If travelers experience any fever or shortness of breath during their trip or within 14 days of returning, they should seek medical help immediately and notify any practitioner of their recent travel.2,5

Human to human transmission of MERS-CoV has been documented in several cluster cases, such as among family members and within health care facilities. It is important to make all travelers aware of the virus and how to minimize risks of contracting it. Health care officials in all countries should prepare for the return of these travelers by increasing awareness.

*Countries considered in the Arabian Peninsula and neighboring include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.2

SOURCES:

  1. Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-COV) Infection and Guidance for the Public, Clinicians, and Public Health Authorities, 2012-2013. Centers for Disease Control and Prevention. 2013. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a4.htm. Accessed September 20, 2013.
  2. A Novel Coronavirus Called “MERS-Cov” in the Arabian Peninsula. Centers for Disease Control and Prevention. 2013. Available at: http://wwwnc.cdc.gov/travel/notices/watch/coronavirus-arabian-peninsula-uk. Accessed September 20, 2013.
  3. MERS: transmitted from animals to humans “on several occasions”. Medical News Today. 2013. Available at: http://www.medicalnewstoday.com/articles/266345.php. Accessed September 20, 2013.
  4. Hajj and Umrah, 2013. Centers for Disease Control and Prevention. 2013. Available at: http://www.cdc.gov/Features/HajjAndUmrah/. Accessed November 1, 2013.
  5. World- travel advice on MERS-CoV for pilgrimages. World Health Organization. 2013. Available at: http://www.who.int/ith/updates/20130725/en/. Accessed September 25, 2013.

 

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