https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON380
SITAATTI 24.5. 2022
On
28 April 2022, WHO was notified of a case of Middle East Respiratory
Syndrome Coronavirus (MERS-CoV), in a 34-year-old male, from Al Dhahira
Governorate in Oman. The case had a history of direct contact with
animals including dromedaries, sheep and goats at his family farm in
Oman. The condition of the case remains critically unstable. As of 28
April, a total of six close community and 27 health care workers had
been listed as contacts and were followed for 14 days from the date of
last exposure with the case. No secondary cases have been reported to
date.
Description of the case
On 28 April 2022, the National IHR Focal point of Oman notified WHO of one case of MERS-CoV from Al Dhahira Governorate in Oman.
The
case, a 34-year-old male, non-health care worker who is a resident of
Al Dhahira Governorate, developed symptoms including shortness of
breath, high-grade fever, and dry cough on 18 April which lasted for six
days. On 24 April, he was taken to the emergency department of a
hospital. Upon examination and assessment, he was found to be in severe
respiratory distress, febrile, and hypotensive and diagnosed with
clinical pneumonia with fluid collection in the lungs and was admitted
to the isolation ward. The condition of the patient deteriorated, and he
was immediately transferred to a negative pressure isolation room, in
the medical ward on the same day. On 25 April, his condition worsened,
and he was then transferred to an isolation room in the Intensive Care
Unit (ICU) and placed on mechanical ventilation. Respiratory samples
were tested for several viral pathogens, including severe acute
respiratory syndrome coronavirus (SARS-CoV) and Mycobacterium
tuberculosis. A sepsis workup including blood and urine tests was
performed and tested positive for MERS-CoV by reverse transcription
polymerase chain reaction (RT-PCR) on 27 April.
As
of 8 May, the condition of the patient remains critically unstable and
he continues to be mechanically ventilated in an isolation room in the
ICU. The patient has no known co-morbidities. There was no history of
contact with similar cases, no history of travel nor previous
hospitalization. However, the patient has a history of direct contact
with animals including dromedaries, sheep and goats at his family farm
in Oman.
Epidemiology of the disease
Middle
East respiratory syndrome (MERS) is a viral respiratory infection that
is caused by a coronavirus called Middle East Respiratory Syndrome
Coronavirus (MERS-CoV). Infection with MERS-CoV can cause severe disease
resulting in high mortality. Approximately 35% of patients with MERS
have died, but this may be an overestimate of the true mortality rate,
as mild cases of MERS-CoV may be missed by existing surveillance systems
and until more is known about the disease, the case fatality rates are
counted only amongst the laboratory-confirmed cases.
Humans
are infected with MERS-CoV from direct or indirect contact with
dromedary camels who are the natural host and zoonotic source of the
MERS-CoV infection. MERS-CoV has demonstrated the ability to transmit
between humans. So far, the observed non-sustained human-to-human
transmission has occurred among close contacts and in health care
settings. Outside of the healthcare setting there has been limited
human-to-human transmission.
MERS-CoV
infections range from showing no symptoms (asymptomatic) or mild
respiratory symptoms to severe acute respiratory disease and death. A
typical presentation of MERS-CoV disease is fever, cough and shortness
of breath. Pneumonia is a common finding, but not always present.
Gastrointestinal symptoms, including diarrhoea, have also been reported.
Severe illness can cause respiratory failure that requires mechanical
ventilation and support in an intensive care unit. The virus appears to
cause more severe disease in older people, persons with weakened immune
systems and those with chronic diseases such as renal disease, cancer,
chronic lung disease, and diabetes.
No vaccine or specific
treatment is currently available, although several MERS-CoV specific
vaccines and treatments are in development. Treatment is supportive and
based on the patient’s clinical condition.
Public health response
- As of 28 April, a total of six close community and 27 health
care workers were listed as contacts and followed up for 14 days from
the last date of exposure to the MERS-CoV patient. All high-risk
contacts, such as healthcare workers, were monitored for symptoms and
screened for MERS CoV by RT-PCR as per the Ministry of Health Infection
Prevention and Control guideline for MERS-COV exposures and cases. No
secondary cases have been reported to date from Oman.
- Infection, prevention and control (IPC)measures were implemented in the hospital where the patient was admitted.
- Healthcare workers were educated on MERS and a refresher training course on IPC measures was provided.
- Family
members identified as close contacts of the case were educated on
personal and respiratory hygiene to prevent further transmission
- The
Ministry of Agriculture has investigated the farms of the patient’s
family and close relatives; samples from the dromedaries have been
collected for testing. As of 8 May 2022, results remain pending.
WHO risk assessment
Cases of MERS-CoV infection are rare in Oman. Since June 2013, a
total of 25 MERS-CoV cases, including the current case, and seven
deaths, have been reported to WHO from Oman.
As
of 15 May 2022, the total number of laboratory-confirmed MERS-CoV
infection cases reported globally to WHO is 2591 including 894
associated deaths. The majority of the reported cases have occurred in
countries in the Arabian Peninsula. Outside of this region, there has
been one large outbreak in the Republic of Korea, in May 2015, during
which 186 laboratory-confirmed cases (185 in Republic of Korea and 1 in
China) and 38 deaths were reported. The global number reflects the total
number of laboratory-confirmed cases and deaths reported to WHO under
International Health Regulations (2005) to date.
The
notification of this case does not change the overall risk assessment
for MERS. It is expected that additional cases of MERS-CoV infection
will be reported from the Middle East and/or other countries where
MERS-CoV is circulating in dromedaries, and that cases will continue to
be exported to other countries by individuals who were exposed to the
virus through contact with dromedaries or their products (for example,
consumption of camel’s raw milk), or in a healthcare setting.
WHO continues to monitor the epidemiological situation and conducts a risk assessment based on the latest available information.
WHO advice
Surveillance: Based on the current situation
and available information, WHO re-emphasizes the importance of strong
surveillance by all Member States for acute respiratory infections,
including MERS-CoV, and to carefully review any unusual patterns.
Infection prevention and control in health care settings:
Human-to-human transmission of MERS-CoV in healthcare settings has been
associated with delays in recognizing the early symptoms of MERS-CoV
infection, slow triage of suspected cases and delays in implementing IPC
measures. IPC measures are therefore critical to prevent the possible
spread of MERS-CoV between people, particularly in health care
facilities.
Healthcare workers should always
apply standard precautions consistently with all patients, at every
interaction in healthcare settings:
• Droplet
precautions should be added to the standard precautions when providing
care to 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 or in settings where aerosol-generating
procedures are conducted.
Case management:
Early identification, case management and isolation of cases,
quarantine of contacts, together with appropriate infection prevention
and control measures in health care settings and public health awareness
can prevent human-to-human transmission of MERS-CoV.
MERS-CoV
appears to cause more severe disease in people with underlying chronic
medical conditions such as diabetes, renal failure, chronic lung
disease, and immunocompromised persons. Therefore, people with these
underlying medical conditions should avoid close contact with animals,
particularly dromedary camels, when visiting farms, markets, or barn
areas where the virus is known to be potentially circulating. Timely,
effective, and safe supportive management of patients with MERS should
be provided, particularly for those at risk of more severe disease.
Infection prevention and control in the community:
General hygiene measures, such as regular hand washing before and after
touching animals and avoiding contact with sick animals, should be
adhered to. Food hygiene practices should be observed. People should
avoid drinking raw camel milk or camel urine or eating meat that has not
been properly cooked.
International travel and trade:
WHO does not advise specific MERS-CoV screening at points of entry with
regard to this event, nor does it currently recommend the application
of any travel or trade restrictions.
Further information
For
citable reference: World Health Organization (17 May 2022). Disease
Outbreak News; Middle East respiratory syndrome coronavirus – Oman.
Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON380
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