Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Middle East Respiratory Syndrome
(MERS)
Presented by:
Gaurav Kamboj
JR, Community Medicine
Contents
• Corona Virus
• Middle East Respiratory Syndrome- An Introduction
• Epidemiology and Current status
• Source of ...
Corona Viruses
• Corona viruses are enveloped viruses with
a positive-sense RNA genome and with a
nucleo-capsid of helical...
• Corona viruses primarily infect the upper
respiratory and gastrointestinal tract of
mammals and birds.
• The most public...
Middle East Respiratory Syndrome (MERS-CoV)
• The novel corona virus (MERS-CoV), first detected in April 2012, is a new vi...
MERS-CoV particles as seen by negative stain electron microscopy.
Virions contain characteristic club-like projections ema...
26 Countries reporting MERS cases
>85%
Epidemiology
• As of 19 June 2015, 1338 laboratory-confirmed cases of human
infection with MERS-CoV have been reported to ...
If it's a 'Middle East' virus, why is it exploding
all the way in Korea?
• It all started with one man. On 20th May 2015, ...
MERS-CoV in Republic of Korea
• According to the WHO, the rapid spread of the disease in South
Korea was because of - amon...
Source of the virus
• MERS-CoV is a zoonotic virus that has been transmitted from animals
to humans.
• The origins of the ...
Transmission
Transmission from animals to humans
• It is not yet fully understood how people become infected with MERSCoV,...
Transmission
Transmission from humans to humans
• The virus does not appear to pass easily from person to person unless th...
Symptoms & Complications
• Most people confirmed to have MERS-CoV infection have had severe acute
respiratory illness with...
Clinical Presentation
• A wide clinical spectrum of MERS-CoV infection has been reported ranging from
asymptomatic infecti...
Clinical Course
• The median Incubation period is usually about 5 or 6 days (range 2-14 days) and
the median time from ons...
Laboratory Testing
• Novel Coronavirus 2012 Real-time PCR Assay (NCV-12 rRT-PCR Assay) is used to
conform MERS-CoV in resp...
Laboratory Findings
Laboratory findings at admission may include:
• Leukopenia, lymphopenia, thrombocytopenia, and elevate...
People Who May Be at Increased Risk for
MERS
• Recent Travellers from the Arabian Peninsula
• Develop fever and symptoms o...
People Who May Be at Increased Risk for
MERS
• People recently in a healthcare facility
• Develop a fever and symptoms of ...
People Who May Be at Increased Risk for
MERS
• Healthcare Personnel not using recommended Infection-Control
Precautions
• ...
‘Patient Under Investigation’ (PUI)
A person who has both clinical features and an epidemiologic risk should be considered...
Close Contact
a) Being within approximately 6 feet (2 meters) or within the room or
care area for a prolonged period of ti...
Probable Case
• A PUI having evidence of pulmonary parenchyma disease (e.g.
pneumonia or ARDS) with absent or inconclusive...
Confirmed Case
• A confirmed case is a person with laboratory confirmation of MERS-
CoV infection.
• A case can be confirm...
Treatment
• There is no specific antiviral treatment recommended for MERS-CoV
infection.
• Individuals with MERS can seek ...
Agents which can be used:
• Convalescent plasma
• Interferon
• Protease Inhibitors
• Intravenous Immunoglobulin
• Nitazoxa...
Prevention
• Because neither the source of the virus nor the mode of transmission is
known, it is not possible to give spe...
PREVENTION
Prevention
• Contact with any obviously sick animals
(including birds) should be avoided
• Sick animals should never be sl...
MERS-CoV Vaccine
• Currently, there is no vaccine to prevent MERS-CoV infection
• Novavax on June 6, 2013 announced that i...
Personal protective equipment and
procedures
• Non-sterile patient-care gloves
• Disposable isolation gowns
• Goggles or f...
Traveler's guidelines
• CDC recommends that travellers to countries in or near the Arabian
Peninsula may pay attention to ...
Traveler's guidelines
• CDC does not recommend that
most travelers change their plans
because of MERS.
• However, the Saud...
WHO-SEAR calls for stepping up vigil for MERS,
Thialand confirms case
• On 18th June 2015, Thailand confirmed MERS
CoV dis...
Response to MERS in India
• An alert has been sounded at all airports to screen passengers
especially from Middle East and...
References
• http://www.cdc.gov.in/merscoronavirus
• www.who.int/coronavirus/mers
• http://www.who.int/emergencies/mers-co...
Middle East Respiratory Syndrome: MERS- CoV
Middle East Respiratory Syndrome: MERS- CoV
Middle East Respiratory Syndrome: MERS- CoV
Middle East Respiratory Syndrome: MERS- CoV
Middle East Respiratory Syndrome: MERS- CoV
Middle East Respiratory Syndrome: MERS- CoV
Upcoming SlideShare
Loading in …5
×

Middle East Respiratory Syndrome: MERS- CoV

10,264 views

Published on

The epidemiology, etiology and disease profile caused by MERS-CoV

Published in: Health & Medicine
  • Login to see the comments

Middle East Respiratory Syndrome: MERS- CoV

  1. 1. Middle East Respiratory Syndrome (MERS) Presented by: Gaurav Kamboj JR, Community Medicine
  2. 2. Contents • Corona Virus • Middle East Respiratory Syndrome- An Introduction • Epidemiology and Current status • Source of Virus • Transmission and Clinical Presentation • Laboratory findings • People who may be at risk to MERS-CoV infection • Case definitions • Treatment and Prevention • Traveler's guidelines • Status in India • References
  3. 3. Corona Viruses • Corona viruses are enveloped viruses with a positive-sense RNA genome and with a nucleo-capsid of helical symmetry. • The name "coronavirus" is derived from the Latin corona, meaning crown or halo. • Under electron microscopic examination, each virion is surrounded by a "corona," or halo. This is due to the presence of viral spike peplomers emanating from each proteinaceous envelope.
  4. 4. • Corona viruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. • The most publicized human corona virus, SARS-CoV which causes SARS, has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause gastroenteritis. • Corona viruses are believed to cause a significant percentage of all common colds in human adults Corona Viruses
  5. 5. Middle East Respiratory Syndrome (MERS-CoV) • The novel corona virus (MERS-CoV), first detected in April 2012, is a new virus that has not been seen in humans before. • This new corona virus is now known as Middle East Respiratory Syndrome Corona Virus (MERS-CoV). • Health officials first reported the disease in Saudi Arabia in September 2012. • Through retrospective investigations, health officials later identified that the first known cases of MERS occurred in Jordan in April 2012. • About 3-4 out of every 10 patients reported with MERS have died. (36% - Case fatality rate) • So far, all cases of MERS have been linked to countries in and near the Arabian Peninsula. • MERS can affect anyone. MERS patients have ranged in age from younger than 1 to 99 years old
  6. 6. MERS-CoV particles as seen by negative stain electron microscopy. Virions contain characteristic club-like projections emanating from the viral membrane.
  7. 7. 26 Countries reporting MERS cases >85%
  8. 8. Epidemiology • As of 19 June 2015, 1338 laboratory-confirmed cases of human infection with MERS-CoV have been reported to WHO since 2012, including at least 475 deaths. • Overall, 66% of cases reporting gender (n=1329) are male and the median age is 50 years (range 9 months–99 years; n=1335) • During Ramadan, 1 million pilgrims are expected to arrive in Saudi Arabia in June-July 2015. And MERS remains a threat to global health security.
  9. 9. If it's a 'Middle East' virus, why is it exploding all the way in Korea? • It all started with one man. On 20th May 2015, the Republic of Korea notified WHO of the first laboratory-confirmed case of MERS-CoV. • The index case had recently travelled to the Kingdom of Saudi Arabia (KSA), Qatar, the UAE and Bahrain. The source of his infection remains unknown. • The second case was his wife, the third was his hospital roommate, the fourth was the daughter of the roommate, the fifth was a healthcare professional who treated the first patient, and so on.
  10. 10. MERS-CoV in Republic of Korea • According to the WHO, the rapid spread of the disease in South Korea was because of - among other things - a lack of awareness among the public and healthcare workers about MERS, crowded hospitals and emergency rooms, visitation by too many friends and family members and the practice of 'doctor shopping', or seeking care in multiple hospitals. • This is the largest outbreak of MERS outside the Middle East. • In this outbreak, transmission of MERS-CoV has been strongly associated with health care settings. 14% cases are health care professionals
  11. 11. Source of the virus • MERS-CoV is a zoonotic virus that has been transmitted from animals to humans. • The origins of the virus are not fully understood but, according to the analysis of different virus genomes, it is believed that it originated in bats and was transmitted to Camels sometime in the distant past.
  12. 12. Transmission Transmission from animals to humans • It is not yet fully understood how people become infected with MERSCoV, which is a zoonotic virus. • It is believed that humans can be infected through direct or indirect contact with infected dromedary camels in the Middle East. • Strains of MERS-CoV have been identified in camels in several countries, including Egypt, Oman, Qatar and Saudi Arabia. • The most critical question remains to be answered, that is, the type of human exposures that result in infection. • Most human cases do not have a history of direct contact with camels; if camels or other animals are the source, the route of transmission to humans may be indirect.
  13. 13. Transmission Transmission from humans to humans • The virus does not appear to pass easily from person to person unless there is close contact such as providing clinical care to an infected patient • This has been seen among family members, patients, and health‐care workers. • Undetermined Droplet and direct contact probably Large droplet transmission is suspected as the most likely route. • Majority cases have resulted from human to human transmission in health care settings. • All reported cases have been linked to countries in and near the Arabian Peninsula.
  14. 14. Symptoms & Complications • Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with symptoms of fever (38°C , 100.4°F), cough and shortness of breath • Gastrointestinal symptoms including diarrhea and nausea/vomiting. • More severe complications, such as pneumonia and kidney failure in many cases. • About 3-4 out of every 10 people reported with MERS have died. Most of the people who died had an underlying co-morbid medical condition. • Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered. • People with pre-existing medical conditions (like diabetes; cancer; and chronic lung, heart, and kidney disease) or weakened immune systems may be more likely to become infected with MERS-CoV, or have a severe case.
  15. 15. Clinical Presentation • A wide clinical spectrum of MERS-CoV infection has been reported ranging from asymptomatic infection to acute upper respiratory illness, and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure resulting in death. • Most MERS-CoV cases have been reported in adults (median age approx. 50 years, male predominance), although children and adults of all ages have been infected (range 9 months to 99 years). • At hospital admission, common signs and symptoms include fever, chills/rigors, headache, non-productive cough, dyspnea, and myalgia. • Pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation) is found in most patients • Other symptoms can include sore throat, coryza, nausea and vomiting, dizziness, sputum production, diarrhea, vomiting, and abdominal pain.
  16. 16. Clinical Course • The median Incubation period is usually about 5 or 6 days (range 2-14 days) and the median time from onset of illness to hospitalization is approx. 4 days. • In critically ill patients, the median time from onset to ICU admission is approx. 5 days, and median time from onset to death is approximately 12 days. • Radiographic findings may include unilateral or bilateral patchy densities or opacities, interstitial infiltrates, consolidation, and pleural effusions. • Rapid progression to acute respiratory failure, acute respiratory distress syndrome (ARDS), refractory hypoxemia, and extra-pulmonary complications (like acute kidney injury requiring renal replacement therapy, hypotension requiring vasopressors, hepatic inflammation, septic shock) has been reported.
  17. 17. Laboratory Testing • Novel Coronavirus 2012 Real-time PCR Assay (NCV-12 rRT-PCR Assay) is used to conform MERS-CoV in respiratory, blood and stool samples. • To increase the likelihood of detecting MERS-CoV infection, CDC recommends collecting multiple specimens from different sites at different times after symptom onset. • CDC strongly recommends testing a lower respiratory specimen (e.g., sputum, broncho-alveolar lavage fluid, or tracheal aspirate), a naso/oropharyngeal swab, and serum. • Stool specimens are of lower priority • If symptom onset was more than 14 days prior, CDC also strongly recommends additional testing of a serum specimen via the CDC MERS-CoV serologic assay.
  18. 18. Laboratory Findings Laboratory findings at admission may include: • Leukopenia, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels. • Co-infection with other respiratory viruses and community- acquired bacteria has been reported • Nosocomial bacterial and fungal infections have been reported in mechanically-ventilated patients. • MERS-CoV virus can be detected with higher viral load and longer duration in the lower respiratory tract compared to the upper respiratory tract, and has been detected in feces, serum, and urine. • However, very limited data are available on the duration of respiratory and extra-pulmonary MERS-CoV shedding.
  19. 19. People Who May Be at Increased Risk for MERS • Recent Travellers from the Arabian Peninsula • Develop fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula • Close Contacts of an Ill Traveller from the Arabian Peninsula • Close contact with someone within 14 days after they travelled from a country in or near the Arabian Peninsula, and the traveller has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, health should be monitored for 14 days, starting from the day last exposed to the ill person.
  20. 20. People Who May Be at Increased Risk for MERS • People recently in a healthcare facility • Develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after being in a healthcare facility (as a patient, worker, or visitor) situated in the affected country • Close Contacts of a Confirmed Case of MERS • Monitor health for 14 days, starting from the day last exposed to the ill person. Watch for these symptoms: • Fever. Take temperature twice a day. • Coughing • Shortness of breath • Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.
  21. 21. People Who May Be at Increased Risk for MERS • Healthcare Personnel not using recommended Infection-Control Precautions • People with Exposure to Camels • The WHO has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. • Travellers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. • Travellers should also avoid consumption of raw or undercooked animal products (milk, urine, meat). • High risk groups for severe MERS • People with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems
  22. 22. ‘Patient Under Investigation’ (PUI) A person who has both clinical features and an epidemiologic risk should be considered a patient under investigation (PUI) based on one of the following scenarios: • Fever AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND EITHER: • history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset, OR • close contact with a symptomatic traveller from countries in or near the Arabian Peninsula, OR • history of being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset, OR • a member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated OR • Fever OR symptoms of respiratory illness (not necessarily pneumonia) AND close contact with a confirmed MERS case while the case was ill.
  23. 23. Close Contact a) Being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection) b) Having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye.). c) Any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.
  24. 24. Probable Case • A PUI having evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS) with absent or inconclusive laboratory results for MERS-CoV infection who is a close contact of a laboratory- confirmed MERS-CoV case. • Any person with severe acute respiratory illness with unknown aetiology • An epidemiologic link to a confirmed MERS case.
  25. 25. Confirmed Case • A confirmed case is a person with laboratory confirmation of MERS- CoV infection. • A case can be confirmed by the demonstration of sero-conversion in 2 samples ideally taken at least 14 days apart, by a screening (ELISA, IFA) and a neutralization assay.
  26. 26. Treatment • There is no specific antiviral treatment recommended for MERS-CoV infection. • Individuals with MERS can seek medical care to help relieve symptoms. • For severe cases, current treatment includes care to support vital organ functions. • Any additional benefit of novel pharmacological agents remains uncertain.
  27. 27. Agents which can be used: • Convalescent plasma • Interferon • Protease Inhibitors • Intravenous Immunoglobulin • Nitazoxanide • Cyclosporin A • Ribavirin • Corticosteroids • Interferon plus ribavirin
  28. 28. Prevention • Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection • CDC routinely advises that people help protect themselves from respiratory illnesses by taking everyday preventive actions: • Wash hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. • Cover nose and mouth with a tissue when cough or sneeze, then throw the tissue in the trash. • Avoid touching eyes, nose and mouth with unwashed hands. • Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people. • Clean and disinfect frequently touched surfaces and objects, such as doorknobs.
  29. 29. PREVENTION
  30. 30. Prevention • Contact with any obviously sick animals (including birds) should be avoided • Sick animals should never be slaughtered for consumption. • 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. • Dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items should not be shared with a person who is confirmed to have, or being evaluated for MERS-CoV infection.
  31. 31. MERS-CoV Vaccine • Currently, there is no vaccine to prevent MERS-CoV infection • Novavax on June 6, 2013 announced that it has successfully produced a vaccine candidate designed to provide protection against the recently emerging Middle East Respiratory Syndrome Coronavirus (MERS-CoV). • The vaccine candidate was made using Novavax’ nanoparticle vaccine technology, and is based on the major surface spike (S) protein. • The development of a MERS vaccine candidate currently remains a pre- clinical program
  32. 32. Personal protective equipment and procedures • Non-sterile patient-care gloves • Disposable isolation gowns • Goggles or face shield • Fit-tested, disposable respirators (at least as protective as fit-tested NIOSH-certified disposable N95 filtering facepiece respirators) • Hand hygiene product (e.g., alcohol-based hand rub) Upon exit from the patient room or care area, PPE should be removed and either discarded, or for re-useable PPE, cleaned and disinfected
  33. 33. Traveler's guidelines • CDC recommends that travellers to countries in or near the Arabian Peninsula may pay attention to their health during and after their trip. • Travellers should see a doctor right away if they develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after travelling from countries in or near the Arabian Peninsula. • They should tell the doctor about their recent travel.
  34. 34. Traveler's guidelines • CDC does not recommend that most travelers change their plans because of MERS. • However, the Saudi Arabia Ministry of Health has made special recommendations for travellers to Hajj and Umrah.
  35. 35. WHO-SEAR calls for stepping up vigil for MERS, Thialand confirms case • On 18th June 2015, Thailand confirmed MERS CoV disease in a traveler from Middle East region, the first case in WHO South East Asia Region • Considering the high volume of tourist traffic between India and Thailand, and with the Hajj pilgrimage approaching in mid- September, it makes sense to be vigilant about MERS in India. • More than 1,36,000 Indians are expected to make the pilgrimage to Mecca this year, and Thailand registered 9,46,269 Indian tourists last year. Any one of these visitors could be a potential carrier of MERS to India.
  36. 36. Response to MERS in India • An alert has been sounded at all airports to screen passengers especially from Middle East and South Korea for Middle East Corona Virus (MERS-CoV) • Airports throughout the country have been asked to report any passengers who are self-reporting at immigration counters with symptoms of fever and respiratory distress. • Flights coming from the 26 affected countries have been asked to make an in-flight announcement asking passengers complaining of fever, cough or respiratory distress to report to medical unit at the airport.
  37. 37. References • http://www.cdc.gov.in/merscoronavirus • www.who.int/coronavirus/mers • http://www.who.int/emergencies/mers-cov/en • WHO guidelines on infection prevention and control during health care for probable or confirmed cases of novel coronavirus (nCoV) infection • B Guery et al. Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission. Lancet (2013). • K. Park “Textbook of Preventive and Social Medicine” 22 edition

×