The document summarizes information about two early cases of MERS-CoV (Middle East Respiratory Syndrome Coronavirus) infection. The first case was a 60-year-old Saudi man who was hospitalized with fever and cough and died of acute respiratory distress syndrome. Chest imaging showed worsening bilateral opacities. The second case was a 49-year-old Qatari man who was hospitalized in Qatar and London with pneumonia, respiratory failure, and renal failure after traveling to Saudi Arabia. No severe illnesses were found among the patient's 64 identified contacts.
Taklimat berkenaan MERS-COV (Middle East Respiratory Syndrome-Corona Virus) - 12 Julai 2013
Virus ini mula tersebar di Arab Saudi, dan perhatian lebih perlu diberikan kepada jemaah-jemaah yang baru pulang dari Umrah di Makkah & Madinah, Arab Saudi.
Covid 19 information for dialysis professionals and dialysis providers habeebHABEEB RAHMAN PK
Covid 19 information for dialysis professionals and dialysis providers . I know we are in the front of war against COVID-19 . This guide targeted to dialysis dialysis professionals like dialysis nurses ,dialysis technologist,dialysis technicians , social worker and admin team. Please find attachment
Taklimat berkenaan MERS-COV (Middle East Respiratory Syndrome-Corona Virus) - 12 Julai 2013
Virus ini mula tersebar di Arab Saudi, dan perhatian lebih perlu diberikan kepada jemaah-jemaah yang baru pulang dari Umrah di Makkah & Madinah, Arab Saudi.
Covid 19 information for dialysis professionals and dialysis providers habeebHABEEB RAHMAN PK
Covid 19 information for dialysis professionals and dialysis providers . I know we are in the front of war against COVID-19 . This guide targeted to dialysis dialysis professionals like dialysis nurses ,dialysis technologist,dialysis technicians , social worker and admin team. Please find attachment
Middle East Respiratory Syndrome (MERS) adalah salah satu penyakit new emergence dengan potensi pandemi. Globalisasi menjadi salah satu bahasan menarik yang melingkupi penelitian dan pengetahuan tentang MERS dan dampaknya bagi populasi manusia. Presentasi ini dibawakan di depan mahasiswa Akademi Keperawatan Panti Rapih, Sabtu, 7 Juni 2014, sebagai pengantar kegiatan praktek klinik.
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Webinar: COVID-19 Updates with Stephanie LambertTheChamber
Stephanie Lambert, Health Officer, Manitowoc County Health Department shares some COVID-19 updates for October 2021, view the recording here: https://www.facebook.com/TheChamberofManitowocCounty/videos/377583460764338
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
In light of the rise in MERS CoV cases in the Middle East the Yale-Tulane ESF-8 Planning and Response Program has produced this special report. It was compiled entirely from open source materials. Please feel free to forward the report to anyone who might be interested.
To prevent the spread of COVID-19:
Clean your hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a safe distance from anyone who is coughing or sneezing.
Wear a mask when physical distancing is not possible.
Don’t touch your eyes, nose or mouth.
Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.
Masks
Masks can help prevent the spread of the virus from the person wearing the mask to others. Masks alone do not protect against COVID-19, and should be combined with physical distancing and hand hygiene. Follow the advice provided by your local health authority.
A presentation on MERS-CoV, the causative agent of Middle East Respiratory Syndrome, given during the Advanced Virology course at Middle Tennessee State University in October 2015.
Describes all about SARS CoV- 2 its introduction, epidemiology, life cycle of virus, its transmission, pathophysiology of the disease, its complications, diagnostic methods and management through different system of medicines.
Hello, this presentation is put together to gain general insight about the coronavirus disease (Covid-19) spread across the globe with graphical images, texts and information.
A coronavirus is a kind of common virus that causes an infection in your nose, sinuses, or upper throat. Most coronaviruses aren't dangerous.
In early 2020, after a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. The outbreak quickly spread around the world.
Middle East Respiratory Syndrome (MERS) adalah salah satu penyakit new emergence dengan potensi pandemi. Globalisasi menjadi salah satu bahasan menarik yang melingkupi penelitian dan pengetahuan tentang MERS dan dampaknya bagi populasi manusia. Presentasi ini dibawakan di depan mahasiswa Akademi Keperawatan Panti Rapih, Sabtu, 7 Juni 2014, sebagai pengantar kegiatan praktek klinik.
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Webinar: COVID-19 Updates with Stephanie LambertTheChamber
Stephanie Lambert, Health Officer, Manitowoc County Health Department shares some COVID-19 updates for October 2021, view the recording here: https://www.facebook.com/TheChamberofManitowocCounty/videos/377583460764338
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
In light of the rise in MERS CoV cases in the Middle East the Yale-Tulane ESF-8 Planning and Response Program has produced this special report. It was compiled entirely from open source materials. Please feel free to forward the report to anyone who might be interested.
To prevent the spread of COVID-19:
Clean your hands often. Use soap and water, or an alcohol-based hand rub.
Maintain a safe distance from anyone who is coughing or sneezing.
Wear a mask when physical distancing is not possible.
Don’t touch your eyes, nose or mouth.
Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
Stay home if you feel unwell.
If you have a fever, cough and difficulty breathing, seek medical attention.
Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you, and prevents the spread of viruses and other infections.
Masks
Masks can help prevent the spread of the virus from the person wearing the mask to others. Masks alone do not protect against COVID-19, and should be combined with physical distancing and hand hygiene. Follow the advice provided by your local health authority.
A presentation on MERS-CoV, the causative agent of Middle East Respiratory Syndrome, given during the Advanced Virology course at Middle Tennessee State University in October 2015.
Describes all about SARS CoV- 2 its introduction, epidemiology, life cycle of virus, its transmission, pathophysiology of the disease, its complications, diagnostic methods and management through different system of medicines.
Hello, this presentation is put together to gain general insight about the coronavirus disease (Covid-19) spread across the globe with graphical images, texts and information.
A coronavirus is a kind of common virus that causes an infection in your nose, sinuses, or upper throat. Most coronaviruses aren't dangerous.
In early 2020, after a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. The outbreak quickly spread around the world.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. First Reported Case
• 60 year old Saudi man
• Presented on June 13th with 7d h/o fever and cough; recent
shortness of breath
• Increasing blood urea nitrogen (BUN) and creatinine,
starting day 3 of admission
• White cell count normal on admission(but 92.5% neutrophils)
and increased to a peak of 23,800 cells/cumm on day 10
with neutrophilia, lymphopenia, and progressive
thrombocytopenia
Zaki et al. N Engl J Med 2012 367:1814-20
3. First Case: Chest Radiographs
A: On admission
Zaki et al. N Engl J Med 2012 367:1814-20
Bilateral enhanced pulmonary hilar
vascular shadows (more prominent on
the left) and accentuated
bronchovascular lung markings. Multiple
patchy opacities in middle and lower
lung fields
Opacities more confluent
and dense
B: 2 days later
4. First Case Outcome
• Patient developed acute respiratory distress syndrome
(ARDS) and multiorgan dysfunction syndrome
• Died June 24th
• No close contacts with severe illnesses reported
Zaki et al. N Engl J Med 2012 367:1814-20
5. Second Case
Eurosurv, Vol. 17:40,Oct. 4, 2012
• 49 year old Qatari national
• Timeline: Onset of illness
Onset of illness September 3rd with mild respiratory Sx
September 9th- admission to Qatar hospital with bilateral
pneumonia- subsequent intubation
September 12th admitted to London ICU with respiratory
failure and renal failure
• Fully dependent on ECMO(extracorporeal membrane oxygenation)
• History of travel to Saudi Arabia July 31- Aug. 18, where noted to
have URI symptoms (and traveling companions)
• History of farm (camels and sheep) exposure, but no
history of direct contact with these animals
6. Second Case: Management
Eurosurv, Vol. 17:40,Oct. 4, 2012
• Airborne precautions
• Close contacts monitored for at least 10 days
• 64 contacts identified among healthcare personnel (HCP),
family, and friends
No severe acute respiratory illnesses identified
13 HCP with mild respiratory symptoms
10 HCP negative for MERS-CoV
7. Background
• Middle East respiratory syndrome (MERS)?
MERS is a viral respiratory disease caused by
Coronavirus
Most people confirmed to have MERS-CoV infection
developed severe acute respiratory illness
is related to but is not the same as SARS
First identified– late 2012 in Saudi Arabia
About 30% of people confirmed to have MERS-CoV infection
have died.
April 30, 2014 2
MERS virus - Image from CDC.gov
8. Quick Factoids
Middle East respiratory syndrome (MERS)?
Mortality has been decreasing
75% of recent cases are in the health care setting
75% are secondary transmissions
Only 2 cases known to be tertiary
o Anecdotally more
Season spike is expected
April 30, 2014 2
MERS virus - Image from CDC.gov
9. Infection and Transmission
• Infectious Period
Not clearly established
Likely to extend from the onset of fever until 10 days after fever
resolves
• Incubation Period
Symptoms occurred up to 14 days after last exposure
10.
11. • Zoonotic
Dromedary camel play impt role to human transmisssion
o Viral RNA isolated from nasal/fecal specimens
o MERS-CoV remains infectious beyond 72 hours after introduction
in unpasteurised camel milk
Infection and Transmission
• Human-to-human
Nosocomial transmission
o Hemodialysis unit, intensive care unit, medical ward.
Risk of community transmission has increased as more
human-to-human transmission has been observed.
No large numbers of secondary infections among HCP
household contact after close monitoring
12. • Airborne
• The following have been observed:
• Can transmit from human to human
Seen as clusters and sporadic cases
Not sustained
Transmission between close contacts
Transmission from infected patients to healthcare personnel
• Remains stable as an aerosol and at a low temp
Infection and Transmission
13. Disease Spectrum
• Multiple reports of mild disease and asymptomatic
• Initial symptoms may not be respiratory
o Fever , Cough
o Shortness of breath, Myalgia
• GI illness can be prominent
o Diarrhea, Vomiting
o Abdominal pain
• Some cases have had atypical presentations:
o Initially presented with abdominal pain and diarrhea and later
developed respiratory complications
14. Comorbidities
• Diabetes
• Hypertension
• Chronic cardiac disease
• Chronic renal disease
• Co-infection with other respiratory
viruses and a few cases of co-infection
with community-acquired bacteria at
admission has been reported;
nosocomial bacterial and fungal infections
have been reported in mechanically-
ventilated patients
TheLancet.com Published Online 7/26/13
15. Watch for these symptoms:
• Fever (38°C or higher)
Take your temperature twice a day.
• Coughing
• Shortness of breath
• Other early symptoms to watch:
chills, body aches
sore throat, headache,
diarrhoea, nausea/vomiting, and runny nose.
16. Patient Under Investigation (PUI)
Any PUI should be reported to state and local health departments
immediately
PUI Criteria:
1. Acute respiratory infection, may include fever ≥ 38°C and cough
AND
2. Suspicion of pneumonia or acute respiratory distress syndrome
based on clinical or radiological evidence AND
3. History of travel to the Arabian Peninsula or neighboring
countries within 14 days AND
4. Symptoms not already explained by any other infection or
etiology
17. Patient Under Investigation (PUI)
The following persons may be considered for
evaluation of MERS-CoV:
Persons who develop severe acute lower respiratory
illness of known etiology within 14 days after traveling
from the Arabian Peninsula or neighboring countries, but
who do not respond to appropriate therapy
OR
Persons who develop severe acute lower respiratory
illness who are close contacts of a symptomatic traveler
who developed fever and acute respiratory illness within
14 days of traveling from the Arabian Peninsula or
neighboring countries
18. Confirmed Case Definition
• A confirmed case is any person with laboratory confirmation
of infection with MERS-CoV (PCR)
19. Close Contact
• Any person who provided care for the patient, including a
healthcare worker or family member, or had similarly close
physical contact
• Any person who stayed at the same place (lived with, visited)
as the patient while the patient was ill
20. MERS-CoV and Pregnancy
• very difficult to draw conclusions
on the effect of MERS to
pregnancy.
• pregnant mother considered
high risk group
due to the changes in their
immune response
and the fetal effects of a severe
respiratory syndrome.
21. Collection of Laboratory Specimens
Determine if patient meets PUI criteria
Collect:
An upper respiratory specimen:
Nasopharyngeal AND oropharyngeal swab
A lower respiratory specimen:
Broncheoalveolar lavage, OR
Tracheal aspirate, OR
Pleural fluid, OR
Sputum
Serum for eventual antibody testing
Should be collected during acute phase during first week after onset,
and again during convalescence ≥ 3 weeks later
22. Therapeutics
• Minimal evidence to indicate antiviral or adjunctive
therapy
• Supportive care
• Mechanical ventilation
• Some studies have shown that interferon may have
beneficial effects in the treatment of SARS
23. MERS and Travel
• NO travel restrictions/ban
• Special precautions for travellers to Arabian Peninsula
To reduce risk of infection
o maintain good personal hygiene
wash hands often with soap and water and use antibacterial hand gel regularly;
o avoid consuming undercooked meat and unpasteurised milk, especially from
camels and food prepared in an unsanitary environment;
o wash fruits and vegetables before eating;
24. MERS and Travel
• NO travel restrictions/ban
• Special precautions for travellers to Arabian Peninsula
Use appropriate precautions when in close contact with people
who are ill
Avoid close contact with animal or waste products
o Avoid unnecessary contact with farms, domestic and wild animals,
especially camels.
o Avoid any animal excretions, especially urine and faeces, particularly
from camels and bats
Seek medical attention when flu-like illness or severe respiratory
illness develop during or within 14 days after returning from the
Arabian Peninsula
o advise healthcare providers of any travel history, possible contact with
animals or other sick individuals
The first confirmed case was reported in Saudi Arabia 2012.
Egyptian virologist Dr. Ali Mohamed Zaki isolated and identified a previously unknown coronavirus from the man's lungs.
Dr. Zaki then posted his findings on 24 September 2012 on ProMED-mail.
The isolated cells showed cytopathic effects (CPE), in the form of rounding and syncytia formation.
A second case was found in September 2012. A 49-year-old male living in Qatar presented similar flu symptoms, and a sequence of the virus was nearly identical to that of the first case.[4]
In November 2012, similar cases appeared in Qatar and Saudi Arabia.
Additional cases were noted, with deaths associated, and rapid research and monitoring of this novel coronavirus began
Virus from second case compared to virus isolated from lung tissue of first case
99.5% identity: One nucleotide mismatch over regions (replicase) compared
Genome sequence: JX869059.1
MERS-CoV and Severe Acute Respiratory Syndrome (SARS) are the same family of viruses
Coronaviruses are common and are typically associated with mild upper respiratory illness
Rarely some types of coronaviruses produce more severe illness
May cause mildto severe illness
Evidence of person-to-person transmission
Nosocomial spread with healthcare personnel transmission
Focus in the Arabian Peninsula
~ 50% mortality rate
No cases identified in the U.S.
This strain of coronavirus that causes MERS was first identified in 2012 in Saudi Arabia. Our understanding of the virus and the disease it causes is continuing to evolve
All the clusters of cases seen so far have been transmitted between family members or in a health care setting, the WHO said in an update .
Human-to-human transmission occurred in at least some of these clusters, however, the exact mode of transmission is unknown.
That means it's not yet known how humans contract the virus. But, experts say, there has been no evidence of cases beyond the clusters into communities.
The median incubation period for secondary cases associated with limited human-to-human transmission is approximately 5 days (range 2-13 days). In MERS-CoV patients, the median time from illness onset to hospitalization is approximately 4 days.
Zoonotic transmission
There is growing evidence that the dromedary camel is a host species for the MERS-CoV and that camels play an important role in the transmission to humans [2,3].
The first evidence of the implication of dromedary camels in transmission was the detection of high rates of MERS-CoV antibodies in dromedary camels on the Arabian Peninsula [4,5].
Evidence of infection in camels precedes the first evidence of human infection [6,7].
Recently, viral RNA has been detected in different specimens from camels and the virus has been isolated from nasal and faecal samples [6,8-12].
The detection of MERS-CoV in dromedary camels imported from Sudan and Ethiopia for slaughter in Egypt [9], as well as serological evidence of previous MERS-CoV infection in dromedaries in Ethiopia, Kenya [13], Nigeria [14], Tunisia [14] and the Canary Islands (Spain; some originating from Morocco) [5] suggests that the virus could be geographically widespread in the dromedary camel populations on the African continent and that previously undetected transmission to humans may occur outside of the Arabian Peninsula [14].
However, in two studies, the absence of MERS-CoV antibodies was reported respectively in 226 and 179 abattoir workers in Saudi Arabia (from Jeddah and Makkah sampled in October 2012) and in Egypt (June-December 2013), suggesting a the virus is not easily transmitted from camels to humans [9,15].
Among the primary cases reported from Saudi Arabia, only a minority have documented camel contact.
A recent study showed that the MERS-CoV remains infectious beyond 72 hours after introduction in unpasteurised camel milk [16].
The consumption of raw camel milk is traditional in the Arabic culture.
So far, to our knowledge, no study has looked at the excretion rate of MERS-CoV in camel milk and urine. Raw camel milk may therefore play a role in transmission.
In a prospective study of two camel herds in Saudi Arabia from November 2013 to February 2014, nasal, oral, or rectal swabs and blood samples were collected up to five times.
The study showed that acute MERS-CoV infections diagnosed with PCR resulted in increased anti MERS-CoV titers.
The infection of very young animals (<one month) indicates that maternal antibodies may not fully protect very young animals from infection.
There was no evidence of prolonged virus shedding or viraemia among the tested animals [10].
Human-to-human transmission
While the source or reservoir of MERS-CoV is unknown, the disease is transmitted from person to person, for example by close contacts or in healthcare facilities [17-24].
Based on information related to the first 77 cases, the basic reproduction number of the infection (R0) was estimated to be 0.69 (95% CI 0.50–0.92) at the time [25], indicating a low pandemic potential [26].
For comparison, the R0 was estimated to be 0.80 (95% CI 0.54–1.13) for SARS-CoV, using the same methodology [25].
However, the small number of confirmed cases used for this calculation, the increasing detection of asymptomatic cases and the potential evolution of the virus will probably modify these figures [27].
An investigation of community transmission among household contacts of 26 clusters with 280 contacts over six months in 2013 showed nine positive cases by serology and PCR revealing an R0 of 0.35 (Memish, personal communication).
Nosocomial transmission has been a hallmark of MERS-CoV [28] [29] and has resulted in an upsurge of cases during spring 2014 [30].
A large outbreak was previously documented in Al-Ahsa, Saudi Arabia in 2013.
Twenty-three confirmed and 11 probable cases were diagnosed as part of a single outbreak that involved four healthcare facilities [17].
The majority of cases were hospitalised patients but five family members and two healthcare workers were also affected.
The haemodialysis unit was the most heavily affected, with nine confirmed cases, but transmission also occurred in the intensive care unit and the medical ward.
Sequencing of viral isolates from this outbreak suggested multiple introductions to the facility rather than a single one [17] [30].
Strict infection control measures allowed the containment of outbreaks when implemented e.g. in Al-Ahsa.
Virus shedding in urine has been observed in a human case up to 13 days after symptom onset, in stool up to 16 days and from oronasal swabs up to 16 days after onset of symptoms [31].
In another study, a tracheal aspirate sample was shown to be viral nucleotide positive 20 days after onset of disease [21].
However, this does not yet confirm for how long the infectious virus is shed.
The detection of MERS-CoV in a sample is obviously affected by the time of sampling with regard to the onset of disease; type of sample; sensitivity and specificity values of the laboratory tests available, and the prevalence of the MERS-CoV in the population to which the test is applied.
There is no information available about virus shedding among infected camels.
The shedding in urine among humans makes it plausible that this also applies to camels.
Therefore, taking into account the occasional use of camel urine as traditional medicine in the Arabic culture, the possibility of urine as a source of infection should not be disregarded [55].
However, to date, no urinary route secondary case has been confirmed.
Faecal transmission was indicated as the most likely route for the nosocomial case in France
Asymptomatic and mildly symptomatic healthcare workers have been identified.
One study reported seven MERS cases in Saudi Arabia (two asymptomatic and five symptomatic) confirmed by RT-PCR.
All were women, six had no pre-existing conditions. All had contact with a known MERS case and most were linked to lapses in infection control while taking care of the patients.
No secondary cases were identified from these healthcare workers [32]. In Germany and the United Kingdom [20,22,31], a follow-up screening exercise of nearly 200 personal contacts and healthcare workers exposed to two imported confirmed cases found no evidence of human-to-human transmission [20,22,31].
No tertiary cases were identified from these healthcare workers [32].
Limited clusters of close contacts (one or two secondary cases among close contacts) were identified in Tunisia and Saudi Arabia [31].
The risk of community transmission has increased as more human-to-human transmission has been observed.
MERS is not only easily transmitted from patient to patient, but also from the transfer of sick patients to other hospitals.
in humans, the virus has a strong tropism for nonciliated bronchial epithelial cells, and it has been shown to effectively evade the innate immune responses and antagonize interferon (IFN) production in these cells. This tropism is unique in that most respiratory viruses target ciliated cells
Due to the clinical similarity between MERS-CoV and SARS-CoV, it was proposed that they may use the same cellular receptor; the exopeptidase, angiotensin converting enzyme 2 (ACE2).[14] However, it was later discovered that neutralization of ACE2 by recombinant antibodies does not prevent MERS-CoV infection.
This has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause Gastroenteristis.
Eight clusters of illnesses have been reported by six countries
common signs and symptoms include fever, chills/rigors, headache, non-productive cough, dyspnea, and myalgia. Other symptoms can include sore throat, coryza, nausea and vomiting, dizziness, sputum production, diarrhea, vomiting, and abdominal pain.
Atypical presentations including mild respiratory illness without fever and diarrheal illness preceding development of pneumonia have been reported.
Patients who progress to requiring admission to an intensive care unit (ICU) often have a history of a febrile upper respiratory tract illness with rapid progression to pneumonia within a week of illness onset.
Co-infection with other respiratory viruses and a few cases of co-infection with community-acquired bacteria at admission has been reported; nosocomial bacterial and fungal infections have been reported in mechanically-ventilated patients
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),
A close contact is defined as a healthcare worker or family member providing direct patient care or anyone who had prolonged (>15 minutes) face-to-face contact with a probable or confirmed symptomatic case in any closed setting.
Close contacts should have a baseline serum sample collected and stored, which can be used for comparison of paired sera if required later.
Where local epidemiology allows, it is also advisable to collect airway specimens for PCR testing.
There have been less of a handful cases of confirmed MERS-CoV in pregnancy. So it is very difficult to draw conclusions on the effect of MERS to pregnancy.
However traditionally pregnant mother are considered to be in the high risk group for MERS complications due to the changes in their immune response and the fetal effects of a severe respiratory
use of CDC's 2012 real-time reverse transcription–PCR assay to test for MERS-CoV in clinical respiratory, blood, and stool specimens.
PCR testing should be performed with samples from:
Lower respiratory tract specimens:
Broncheoalveolar lavage, tracheal aspirate, pleural fluid and/or sputum
Typically have highest yield
Upper respiratory tract specimens
Nasopharyngeal and oropharyngeal swabs
Serum
Stool
OCHCA can arrange testing
What specimen to collect
Nasal washes are not acceptable. Use only synthetic fiber swabs with plastic shafts.
To increase the likelihood of detecting infection, please submit specimens from different sites and from different times after symptom onset.
Do not use calcium alginate or wooden shaft swabs.
State labs were sent materials to test for MERS virus from CDC.
For inpatient suspected cases: airborne, droplet and contact precautions.
Cases that meet the criteria for “patient under investigation” must be reported to the state and CDC.
No travel restrictions or border screening have been announced at this time.
Lower respiratory specimens (sputum, bronchoalveolar lavage, endotracheal) are a priority respiratory specimen for real time reverse transcription polymerase chain reaction (RT-PCR) testing
Respiratory (lower and upper tracts), stool, and serum specimens
Specimen collection at different times
No vaccines developed as of yet
No antivirals identified as of yet
Treatment is supportive
Travellers from the EU/EEA to the Arabian Peninsula and its neighbouring countries need to be aware of the presence of MERS-CoV in this area and of the small risk of infection.
Travellers from the EU to the Arabian Peninsula should:
• Consult their doctor before travelling if suffering from serious or severe medical conditions (such as diabetes, chronic lung, renal disease or immunodeficiency) that may increase the likelihood of illness including MERS-CoV infection, or the likelihood of contact with healthcare facilities while in the region.
• Avoid travelling if ill with an infectious disease.
Pilgrims planning to attend the Hajj or Umrah should comply with the Saudi Arabian Ministry of Health’s health regulations from 2013.
They recommend that the elderly (over 65 years), pregnant women, children (under 12 years), those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency postpone the performance of the Hajj and Umrah for their own safety.
All EU/EEA visitors to, and EU/EEA citizens residing in the Arabian Peninsula should:
• Follow general health travel precautions to lower the risk of infection:
– wash hands often with soap and water and use antibacterial hand gel regularly;
– maintain good personal hygiene;
– avoid consuming undercooked meat and unpasteurised milk, especially from camels;
– avoid consuming food prepared in an unsanitary environment;
– wash fruits and vegetables before eating;
– use appropriate precautions when in close contact with people who are ill, especially those with flu-like symptoms (respiratory illness), diarrhoea (and other gastrointestinal illness) or other potentially infectious diseases.
The measures above are especially important when visiting or staying in healthcare facilities in the region, where most of the transmission to humans appears to be occurring.
• Avoid unnecessary contact with farms, domestic and wild animals, especially camels.
• Avoid any animal excretions, especially urine and faeces, particularly from camels and bats.
• Seek medical attention if developing flu-like illness or severe respiratory illness while travelling or within 14 days after returning from the Arabian Peninsula and advise healthcare providers of any travel history, possible contact with animals or other sick individuals.
• If ill with a potentially infectious disease:
– use appropriate cough etiquette (coughing and sneezing into your elbow and using disposable tissues);
– avoid close contact with other people to keep from infecting them;
– avoid participating in food production or preparation;
– wash hands often with soap and water and use antibacterial hand gel regularly;
− maintain good personal hygiene.
CDC does not recommend that anyone change their travel plans because of MERS. The current CDC travel notice is an Alert (Level 2), which provides special precautions for travelers.
Because spread of MERS has occurred in healthcare settings, the alert advises travelers going to countries in or near the Arabian Peninsula to provide healthcare services to practice CDC’s recommendations for infection control of confirmed or suspected cases and to monitor their health closely.
Travellers who are going to the area for other reasons are advised to follow standard precautions, such as hand washing and avoiding contact with people who are ill.
Travellers from the EU/EEA to the Arabian Peninsula and its neighbouring countries need to be aware of the presence of MERS-CoV in this area and of the small risk of infection.
Travellers from the EU to the Arabian Peninsula should:
• Consult their doctor before travelling if suffering from serious or severe medical conditions (such as diabetes, chronic lung, renal disease or immunodeficiency) that may increase the likelihood of illness including MERS-CoV infection, or the likelihood of contact with healthcare facilities while in the region.
• Avoid travelling if ill with an infectious disease.
Pilgrims planning to attend the Hajj or Umrah should comply with the Saudi Arabian Ministry of Health’s health regulations from 2013.
They recommend that the elderly (over 65 years), pregnant women, children (under 12 years), those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes) and pilgrims with immune deficiency postpone the performance of the Hajj and Umrah for their own safety.
All EU/EEA visitors to, and EU/EEA citizens residing in the Arabian Peninsula should:
• Follow general health travel precautions to lower the risk of infection:
– wash hands often with soap and water and use antibacterial hand gel regularly;
– maintain good personal hygiene;
– avoid consuming undercooked meat and unpasteurised milk, especially from camels;
– avoid consuming food prepared in an unsanitary environment;
– wash fruits and vegetables before eating;
– use appropriate precautions when in close contact with people who are ill, especially those with flu-like symptoms (respiratory illness), diarrhoea (and other gastrointestinal illness) or other potentially infectious diseases.
The measures above are especially important when visiting or staying in healthcare facilities in the region, where most of the transmission to humans appears to be occurring.
• Avoid unnecessary contact with farms, domestic and wild animals, especially camels.
• Avoid any animal excretions, especially urine and faeces, particularly from camels and bats.
• Seek medical attention if developing flu-like illness or severe respiratory illness while travelling or within 14 days after returning from the Arabian Peninsula and advise healthcare providers of any travel history, possible contact with animals or other sick individuals.
• If ill with a potentially infectious disease:
– use appropriate cough etiquette (coughing and sneezing into your elbow and using disposable tissues);
– avoid close contact with other people to keep from infecting them;
– avoid participating in food production or preparation;
– wash hands often with soap and water and use antibacterial hand gel regularly;
− maintain good personal hygiene.
CDC does not recommend that anyone change their travel plans because of MERS. The current CDC travel notice is an Alert (Level 2), which provides special precautions for travelers.
Because spread of MERS has occurred in healthcare settings, the alert advises travelers going to countries in or near the Arabian Peninsula to provide healthcare services to practice CDC’s recommendations for infection control of confirmed or suspected cases and to monitor their health closely.
Travellers who are going to the area for other reasons are advised to follow standard precautions, such as hand washing and avoiding contact with people who are ill.