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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - May 2014

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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - May 2014

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  2. 2. Professor Ali Mohamed Zaki, who diagnosed the first patient with a strain of the novel coronavirus in Saudi Arabia, stands in his office in Cairo. 5
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  4. 4. MERS Cases and Deaths, April 2012 – November 1, 2013 Countries Cases (Deaths)  France 2 (1)  Italy 1 (0)  Jordan 2 (2)  Qatar 7 (3)  Saudi Arabia 124 (52)  Tunisia 3 (1)  United Kingdom (UK) 3 (2)  United Arab Emirates (UAE) 6 (2)  Oman 1 (0)  Total 149 7 (63)
  5. 5. 24 April 2014  Since April 2012, reporting countries in the Middle East include Jordan, Kuwait, Oman, Qatar, Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE)  in Europe: France,Germany, Greece, Italy and the United Kingdom (UK)  in North Africa: Tunisia  in Asia: Malaysia and the Philippines. 8
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  7. 7. 7 May 2014  Globally, from September 2012 to date, WHO has been informed of a total of 496 laboratory-confirmed cases of infection with MERS-CoV.  This total includes 229 cases reported between 11 April and 4 May by Saudi Arabia, and the recent reports of 3 cases from Jordan, and one case each from Egypt, the United States, and Yemen.  About 30% of these people died 10
  8. 8.  The occurrence of new cases seems to follow a seasonal pattern, with increasing incidence from March‐April onwards.  The number of cases sharply increased since mid‐March 2014, essentially in KSA and UAE, where two important health care‐associated outbreaks are occurring. 11
  9. 9. WHO RISK ASSESSMENT 24 April 2014  As much as 75% of the recently reported cases appear to be secondary cases, meaning that they are considered to have acquired the infection from another infected person.  The majority of these secondary cases are mainly healthcare workers who have been infected within the healthcare setting, although several patients who were in the hospital for other reasons are also considered to have been infected with MERS‐CoV in the hospital . 12
  10. 10.  The majority of the infected healthcare workers presented with no or minor symptoms.  No large family cluster has been identified.  Screening of contacts revealed very few instances of household transmission; and no increase in the size or number of household or community clusters has been observed.  When human‐to‐human transmission occurred, transmission was not sustained 13 WHO RISK ASSESSMENT 24 April 2014
  11. 11.  The number of cases who acquired the infection in the community has also increased since mid‐ March.  These cases have no reported contacts with other laboratory confirmed cases, and some have reported contacts with animals.  Although camels are suspected to be the primary source of infection for humans, the exact routes of direct or indirect exposure remain unknown. 14 WHO RISK ASSESSMENT 24 April 2014
  12. 12.  In view of the increasing number of cases – in particular secondary cases, nosocomial outbreaks and exported cases  The majority of the cases now reported have likely acquired infection throug human‐to‐human transmission and only about a quarter are considered as primary cases, which suggests slightly more human‐to‐human transmission than previously observed. 15 WHO RISK ASSESSMENT 24 April 2014
  13. 13. Has the transmission pattern of MERS‐CoV changed?  One hypothesis is that the transmission pattern and transmissibility have not changed and that the occurrence of two large nosocomial outbreaks reflects inadequate infection prevention and control measures, coupled with intensive contact tracing and screening.  An alternative hypothesis is that transmissibility of the virus has increased and is resulting in more human‐to‐human transmission as the basis for the recent upswing in cases. 16
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  16. 16.  All of the laboratory confirmed cases had respiratory disease as part of the illness, and most had severe acute respiratory disease requiring hospitalization  Most people who got infected with MERS-CoV developed severe acute respiratory illness with symptoms of fever, cough, shortness of breath and breathing difficulties. .  Pneumonia has been the most common clinical presentation 19 Clinical Features
  17. 17.  In people with immune deficiencies, the disease may have an atypical presentation.  Many have also had gastrointestinal symptoms, including diarrhoea.  Most patients were reported to have at least one comorbidity. 20 Clinical features
  18. 18. Clinical features Complications in fatal cases 1. Acute respiratory distress syndrome (ARDS) 2. Acute Renal failure requiring hemodialysis 3. Disseminated intravascular coagulation ( DIC ) 4. Pericarditis. 5. Multiple organ failure ● Fatality rate ~ 30%
  19. 19. Diagnosis  The main test for this particular coronavirus is a screening PCR tests (polymerase chain reaction) test followed by a more specific confirmatory test  Nasopharyngeal swabs may be less sensitive than specimens of the lower respiratory tract according to WHO, June 2013. 22
  20. 20. Laboratory testing  Collect specimens for MERS-CoV testing from all PUIs (patient under investigation) – An upper respiratory specimen:  Nasopharyngeal AND oropharyngeal swab – A lower respiratory specimen:  Sputum, OR  Broncheoalveolar lavage, OR  Tracheal aspirate, OR  Pleural fluid 23
  21. 21.  Patient samples from the lower respiratory tract, not just the nasopharynx/throat.  if lower respiratory tract specimens are not possible both nasopharyngeal and oropharyngeal swab specimens should be collected, as well as stool and serum. 24 Laboratory testing
  22. 22. WHO criteria for “patient under investigation (PUI)” for MERS-CoV infection
  23. 23. Who should be investigated?  SARI + PPD + either – Traveled to middle east - 14 days – In a cluster (within 14 days ) – HCW exposed to pt with severe LRTI – unexpected clinical course unexplained by current aetiology  ARI of any severity – Close contact with confirmed/probable MERS-CoV ( within 14 days)  Middle East, any ventilated pt SARI = severe acute respiratory illness PPD = pulmonary parenchymal disease 26
  24. 24. SARI + PPD + either  Cluster (>1 persons in a specific setting -classroom, workplace, household, extended family, hospital, other residential institution, military barracks or recreational camp) that occurs within 14-days, WRTHOT unless another aetiology identified (UAAI).  HCW working with severe ARI patients (particularly ICU) WRTHOT UAAI  travel to the Middle East within 14 days before onset of illness, UAAI.  Unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, WRTHOT , even if another aetiology has been identified, if it does not fully explain the presentation or clinical course of the patient. WRTHOT = without 27 regard to history of travel
  25. 25. تعريف مؤقت لحالة العدوى المستجده بفيروس )3/7/ كورونا ) 2013 )مريض قيد الفحص(: شخص مصاب بعدوى مرض تنفسى حاد ) سعال وضيق فى التنفس  والتهاب رئوى شعبى يتم تشخيصه بالكشف الاكلينيكى او بالاشعه ( قد تكون مصحوبه بارتفاع بدرجة الحراره اكثر من او يساوى 38 درجه مئويه. مع:  -1 تاريخ للسفر او الاقامه خلال 14 يوم قبل ظهور الاعراض فى منطقه ابلغ فيها بالأونه الاخيره عن الاصابه بعدوى مستجده بفيروس كورونا ) دول شبه الجزيره العربيه( او اى منطقه قد يظهر فيها عدوى المرض. أو -2 ظهور الاعراض والعلامات السابقه لحالات مجمعه ) حالتان أو اكثر ظهرت عليهم الاعراض خلال نفس فترة 14 يوم ومرتبطين بالمكان ) مدرسه ، منزل، مكان عمل، .... الخ(. أو 28
  26. 26. )تابع مريض قيد الفحص(: -3 حاله تتعامل فى مجال تقديم الخدمه الصحيه لمرضى مصابين بعدوى تنفسيه حاده خاصه مراكز العنايه المركزه. أو -4 حاله لديها التهاب رئوى غير معروف السبب خاصة الحالات سريعة التدهور برغم العلاج المناسب. أو -5 جميع حالات العدوى التنفسيه الشديده الموجوده على جهاز التنفس الصناعى. الحالات المحتمله :  شخص ينطبق عليه تعريف الحاله ) مريض قيد الفحص( المذكور عالية مع مخالطة مباشره خلال 14 يوم قبل ظهور الاعراض لشخص مصاب بحاله مؤكده معمليا. 29
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  29. 29. How can people protect themselves from getting MERS-CoV?
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  33. 33. Infection control Standard precautions + Droplet precautions + Contact precautions Airborne for aerosol generating proceedures 38
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  43. 43. Final Messages! “The only thing more difficult than planning for an emergency is having to explain why you didn’t.” Be Proactive NOT Reactive!!!!
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