The document discusses the 2003 SARS outbreak and the more recent emergence of MERS-CoV. It provides details on: - The international spread of SARS from Hong Kong to multiple countries in 2003, killing 775 people. - Key facts about MERS-CoV, a novel coronavirus first identified in Saudi Arabia in 2012 that is causing severe respiratory illness, with a case fatality rate of around 45%. As of November 2013, 149 cases and 63 deaths had been reported across several countries linked to the Middle East. - Ongoing research investigating the virus's origin and transmission, though its animal reservoir remains unclear. Bats and camels are suspected but the exact source is still unknown.

4. 4
Infectious diseases in a globalized world

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16. 16

17. SARS
(severe acute respiratory syndrome)
 SARS (severe acute respiratory syndrome) outbreak
of 2003 – an epidemic caused by a coronavirus.
 Ten years ago, that epidemic swept across the
world, killing 775 people.
17

18. 18

19. SARS: international spread from Hong Kong,
Doctor
from
Guangdong
Canada
Hotel M
Hong Kong
Ireland
USA
New York
Singapore
Viet Nam
Bangkok
B
I
K
F G
E
D
C
J
H
A
Germany
1 HCW +
2
Source:
WHO/CDC
21 February – 12 March, 2003
Hong Kong
+ 219 health care workers

20. Situation on 15 March, 2003
 Atypical pneumonia with rapid progression to
respiratory failure, none yet recovered
 Health workers appeared to be at greatest risk
 Antibiotics and antivirals did not appear effective
 Spreading internationally within Asia and to Europe and
North America

21. SARS - morbidity
 Most cases are in healthcare workers caring for SARS
patients and close family members of SARS patients
 Overall mortality 10%
 Mortality increases with age
(> 65 years - 50% mortality)
 Children seem to develop mild illness

22. SARS Cases Worldwide Reported to
China (5329)
Hong Kong (1750)
WHO as of June 6, 2003
Vietnam (63)
Singapore (206)
Canada (219)
U.S. (68)
Europe:
8 countries (38)
Thailand (8)
Taiwan (676)
Total: 8404 cases; 779 deaths (~10%case fatality)
Australia&NZ (6)
SA (2)

23. On 5 July 2003 WHO said outbreak
was contained
23

24. 24
How the lessons of SARS could
save us today
People wear masks on the streets of Hong Kong following
the outbreak of SARS, March 2003.

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27. 27

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30. 30

31. Strategies to control: WHO travel
recommendations
on www.who.int/csr/sars/
Update 79 - Situation in China
China’s Executive Vice Minister of Health, Mr Gao
Qiang, and
WHO’s Executive Director for Communicable
Diseases briefed the press this morning on the
situation of SARS control in China. Also in
attendance were Dr Qi Ziaoqiu, Director-General of
the Department of Disease Control in the Chinese
Ministry of Health, and Dr Henk Bekedam, WHO
Representative
to China.
Cumulative Number of
Reported Probable Cases Of
SARS
From: 1 Nov 20021 To: 2 June 2003, 18:00
GMT+2
Revised: 3 June 2003, 9.00 GMT +2
Country Cumulative number of
case(s)2 Number of new cases
Brazil 2 0 0 2 10/Apr/2003 24/Apr/2
003
Canada 198 10 30 116 1/Jun/2003 1/
Jun/2003
China 5328 2 334 3495 1/Jun/2003 2
/Jun/2003
SARS Travel
Recommendations
Summary Table
This table, updated daily,
indicates those areas with
recent local transmission of
SARS for which WHO has
issued recommendations
pertaining to international
travel.

32.  The experience of the 2003 SARS outbreak
taught us very clearly that, for airborne
viruses with pandemic potential, prevention
is always far better than cure.
32

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35. 35

36. Holmes, NEJM 2003
-
Coronavirus
The spike glycoproteins create corona,
bind and fuse with host cell membranes

37. Corona virus
 Crown-like spikes
 Enveloped
 SS RNA (+)
 4 main sub-groupings
as alpha, beta , gamma
and delta.
 Examples: SARS

38.  Human coronaviruses were first identified in the
mid 1960s and are named after the crown-like
projections that can be seen on the surface of
the virus.
 In humans Coronaviruses may cause illness
ranging from mild symptoms such as common
cold to more serious respiratory illnesses, such as
Severe Acute Respiratory Syndrome (SARS).
38

39.  Coronaviruses may also infect animals. Most of
these coronaviruses usually infect only one
animal species or, at most, a small number of
closely related species.
 However, SARS-CoV can infect people and
animals, including monkeys, Himalayan palm
civets, raccoon dogs, cats, dogs, and rodents.
39

40. Coronavirus Classification
 Alpha
–Human examples: HCoV-229E, HCoV-NL63
–Pig, dog, and cat CoVs
 Beta
–HCoV-OC43, HCoV-HKU1, HCoV-SARS
–MHV, rat, pig and cow CoVs
–MERS-CoV
 Gamma
–Chicken and turkey CoVs
 Delta
–Bird CoVs

41. Corona viruses (CoVs)
 Six human CoVs (HCoVs) have been identified
to date:
–HCoV-229E
–HCoV-OC43
–HCoV-NL63
–HCoV-HKU1
–SARS-CoV
–Middle East Respiratory Syndrome Corona virus

42. 42
New Deadly
Respiratory Virus

43. Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
 Is a novel coronavirus (nCoV) first reported on 24
September 2012 on ProMED-mail by Egyptian
virologist Dr. Ali Mohamed Zaki in Jeddah, Saudi
Arabia.
 He isolated and identified a previously unknown
coronavirus from the lungs of a 60-year-old male
patient with suspected viral pneumonia and acute
renal failure.
43

44. 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.
44

45. 45

46.  “Middle East Respiratory Syndrome Coronavirus”
(MERS-CoV) is a Novel coronavirus (particular
strain of coronavirus that has not been previously
identified in humans).
 Early reports compared the virus to severe acute
respiratory syndrome (SARS), and it has been
referred to as Saudi Arabia's SARS-like virus
46

47. Is MERS the New SARS?
 Novel coronavirus is a new strain of coronavirus
that has not been previously identified in humans.
 MERS-CoV is the sixth new type of corona virus
like SARS (but still distinct from it and from the
common-cold corona virus).
47

48.  Middle East Respiratory Syndrome Coronavirus
(MERS-CoV) belongs to the genus Betacoronavirus
as does SARS-CoV
 MERS-CoV is not the same coronavirus that caused
severe acute respiratory syndrome (SARS) in 2003.
However, like the SARS virus, the novel coronavirus
is most similar to those found in bats.
48

49.  This new virus is not the SARS virus , they are
distinct from each other.
 Although both viruses are capable of causing
severe disease, current information indicates that
MERS-CoV does not appear to transmit easily
between people whereas the SARS virus was
much more transmissible.
49

50.  MERS-CoV used to be called “novel coronavirus,”
or “nCoV”
 The Coronavirus Study Group (CSG) of the
International Committee on Taxonomy of Viruses
(ICTV) decided in May 2013 to call the novel
coronavirus “Middle East Respiratory Syndrome
Coronavirus” (MERS-CoV) , since all the cases
have had a direct or indirect connection to the
region.
50

51. 51

52. Emergence of a A novel Coronavirus Called
"MERS-CoV" in the Arabian Peninsula
52

53. 2012 Apr – Zarqa, Jordan – Hospital cluster
On 19 Apr 2012, Jordan
MOH reported an
outbreak of pneumonia in
the Zarqa Public Hospital’s
ICU. 7 nurses, 1 doctor
and 1 brother of a nurse
were among the 11
affected. 1 of the nurses
died.
In Nov 2012, testing of
stored samples from two
died patients of this cluster
confirmed novel
coronavirus infection, and
a number of HCWs with
pneumonia associated
with the cases were
considered probable
cases. Index case among
this cluster cannot be
determined. No history of
travel or contact with
animals.

54. 2012 Jun – Jeddah, Saudi Arabia – Sporadic case
60y male, occupation
unknown, no travel
history, “limited
exposure to animals
prior to onset”, onset
on 06.06, hospitalized
on 06.13, died on 06.20.

55. 2012 Sep – Doha, Qatar – Sporadic case
49y male, occupation
unknown, travel history
to Saudi Arabia,
“limited exposure to
animals prior to onset”,
onset on 2012.09.03,
hospitalized on 09.07.

56. 2012 Oct~Nov – Qatar & SA
– Sporadic cases & family cluster
SA case: 45y male.
Qatar case: 45y male.
SA household cluster:
 Father: 70y, many
comorbidities, hospitalized
on 2012.10.14, died on
10.24.
 Son A: 39y, onset on
10.28, died four days later.
 Son B: 31y, similar illness,
test positive, discharged
on 11.20.
 Grandson: similar illness,
test negative, discharged
on 11.20.

57. 2013 Jan~Feb – SA – Sporadic cases
61y female, onset on
2013.01.24, died on
02.10, travel history to
Egypt (2013.01.10-18).
69y male, onset on
2013.02.05, died on
02.19, no contact or
travel history.
39y male, onset on
2013.02.24, died on
03.02.

58. 2013 Jan~Feb – SA→UK – Family cluster
Index case: 60y male, travel to
Pakistan (2012.12.16~2013.01.20)
and Saudi Arabia (01.20~01.28),
onset on 01.26, hospitalized on
01.31, co-infected with influenza
A(H1N1).
Adult female member of
extended family, limited
exposure to the index case on
three occasions in hospital
(possibility of an intermediary
case), onset on 02.05, mild
influenza-like illness.
Adult male household member,
in sustained close contact with
the index case at home, pre-existing
medical conditions,
onset on 02.06, died on 02.17.
Saudi Arabia

59. Line list 15 cases from Apr/12 to
Feb/13
No. Date of onset Age Sex Probable place of infection Outcome cluster
1 2012.04.?? 40 F Jordan Dead
Hospital A
2 2012.04.?? 25 M Jordan Dead
3 2012.06.06 60 M Saudi Arabia Dead
4 2012.09.03 49 M Qatar/Saudi Arabia Alive
5 2012.10.10 45 M Saudi Arabia Alive
6 2012.10.12 45 M Qatar Alive
7 2012.10.14* 70 M Saudi Arabia Dead
8 2012.10.28 39 M Saudi Arabia Dead Family A
9 2012.11.04 31 M Saudi Arabia Alive
10 2013.01.24 61 F Saudi Arabia Dead
11 2013.01.26 60 M Saudi Arabia/Pakistan Alive
12 2013.02.05 ?? F United Kingdom Alive Family B
13 2013.02.06 ?? M United Kingdom Dead
14 2013.02.05 69 M Saudi Arabia Dead
15 2013.02.24 39 M Saudi Arabia Dead
* Date of hospitalization

61. 61

62. 62

63. 63

64. 64
Number of cases of Middle East respiratory
syndrome coronavirus infection (58 fatal
and 72 nonfatal) reported to the World
Health Organization (WHO) as of September
20, 2013, by month of illness onset —
worldwide, 2012–2013

65. MERS Cases and Deaths,
April 2012 – October 18 , 2013
Countries Cases (Deaths)
 France 2 (1)
 Italy 1 (0)
 Jordan 2 (2)
 Qatar 6 (3)
 Saudi Arabia 116 (49)
 Tunisia 3 (1)
 United Kingdom (UK) 3 (2)
 United Arab Emirates (UAE) 6 (2)
Total 139 (60)
65

66. 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 66 (63)

67. Last Updated 1- November -2013
Quick numbers
 Total human cases of MERS-CoV: 149
 Total deaths attributed to infection with
MERS-CoV: 63
 Current Case Fatality Rate (CFRd): ~ 45%
67

68. Global distribution of
MERS-CoV cases
 Cases are all be linked to a point of origin in
the Arabian Peninsula, in particular, the
Kingdom of Saudi Arabia (KSA).
 Nine countries have now reported cases of
human infection with MERS-CoV
68

69.  Countries where cases acquired infection in-country
from an unknown source ,Jordan,
Kingdom of Saudi Arabia (KSA), Qatar, UAE
(United Arab Emirates)
 Countries where cases are associated with
travel or contact with a returned infected
traveler ,Germany, France, Tunisia, UK, Italy
69
Global distribution of
MERS-CoV cases

70. Global distribution of MERS-CoV cases

71.  In France, Italy, Tunisia and the United Kingdom,
limited local transmission has occurred in people
who had not been to the Middle East but who
had been in close contact with laboratory-confirmed
or probable cases.
 No cases have been identified in Egypt uptill
now.
71

72.  All reported cases were directly or indirectly
linked to one of four countries: Saudi Arabia,
Qatar, Jordan, and the United Arab Emirates
countries in or near the Arabian Peninsula
 Most cases were reported by Saudi Arabia.
72

73. 73

74. 74

75. 31 October 2013
 Oman reports first confirmed new
coronavirus infection to WHO
2013-10- 31
75

76. Source of the infection
 No definitive animal host for the MERS-CoV has
been confirmed to date but bats and camels are
suspects for now.
 At this stage the exact origin is unclear, but
studies of the virus’s genetic material suggest that
bat corona viruses are the nearest relatives.
76

77. 77

78. Source of the infection
 Scientists have recently discovered antibodies
circulating within the camel population, which
may have been directed against either the MERS
virus, or a remarkably similar virus.
 Whether this finding has any direct implications
on infectivity and spread amongst the human
population remains to be seen
78

79. Transmission...
 The original source(s), route(s) of transmission to humans,
and the mode(s) of human-to-human transmission
have not been determined.
 Droplet and direct contact probably
 Settings where infection has occurred :
1. Communities : Sporadic cases with unknown exposure
2. Families : contact with infected family members
3. Health care facilities : patients & health care workers
79

80. Confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
(N =55) reported as of June 7, 2013, to the World Health Organization, and history
of travel from the Arabian Peninsula or neighboring countries within 14 days of
illness onset — worldwide, 2012–2013
MMWR. June 14, 2013

81.  Eight clusters (42 cases) have been reported by six
countries (France, Italy, Jordan, Saudi Arabia, Tunisia,
and the UK) among close contacts or in health-care
settings and provide clear evidence of human-to-human
transmission of MERS-CoV.
 So far, all cases have a direct or indirect link to one of
four countries: Saudi Arabia, Qatar, Jordan, and the
United Arab Emirates
81

82.  The mechanism by which transmission occurred in all
of these cases, whether respiratory (e.g. coughing,
sneezing) or contact (contamination of the
environment by the patient), is unknown.
 All clusters reported to date have occurred among
family contacts or in a health care setting.
 Evidence for limited person-to-person transmission in
some clusters
82

83.  Human-to-human transmission is not sustained,
has only been observed in health care facilities
and close family contacts and wide sustained
transmission in the community has not been
observed.
 So far there is only evidence of limited, non-sustained
person-to-person transmission
83

84. Incubation period
 The incubation period might be longer than
previously estimated.
 In consultation with WHO, the period for considering
evaluation for MERS-CoV infection in persons who
develop severe acute lower respiratory illness days
after traveling from the Arabian Peninsula or
neighboring countries has been extended from
within 10 days to within 14 days of travel.
84

85. MERS-CoV- Overall Epidemiology
 Approximately ~ 50% mortality rate
 Median age ~ 50 y (age 24 to 94 years )
–2 pediatric cases reported
 Male predominance (The male-to-female ratio is 1.6 to 1.0 )
 Most cases reported with comorbidities
 Persons with underlying health conditions at increased
risk of severe disease
 18% of the cases occurred in persons who were identified
as health-care workers.
85

86.  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
86
Clinical Features

87.  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.
87
Clinical features

88. 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 ~ 50%

89. Radiological features:
 pulmonary parenchymal disease (pneumonia or
ARDS)
Fatality rate ~ 50%
 A majority of fatal cases of MERS have occurred
among patients with underlying medical
conditions.
89

90. 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.
90

91. 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
91

92.  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.
92
Laboratory testing

93. WHO criteria for “patient under
investigation (PUI)” for MERS-CoV
infection

94. A) A patient with SARI (A person with severe acute
respiratory infection, which may include history of
fever or measured fever (≥ 38 °C, 100.4 °F) and
cough) AND indications of pulmonary parenchymal
disease (e.g. pneumonia or ARDS), based on clinical
or radiological evidence of consolidation, who
requires admission to hospital.
AND any of the following:
1) Clusters of SARI The disease is in a cluster that occurs
within a 14 day period, without regard to place of
residence or history of travel, unless another aetiology
has been identified.
94

95. 2) SARI in health care workers , The disease occurs in
a health care worker who has been working in an
environment where patients with severe acute
respiratory infections are being cared for,
particularly patients requiring intensive care,
without regard to place of residence or history of
travel, unless another aetiology has been
identified.
3) The person has history of travel to the Middle East
within 14 days before onset of illness, unless
another aetiology has been identified.
95

96. 4) Patients with unexplained pneumonia , The person
develops an unusual or unexpected clinical
course, especially sudden deterioration despite
appropriate treatment, without regard to place of
residence or history of travel, even if another
aetiology has been identified, if that alternate
aetiology does not fully explain the presentation
or clinical course of the patient.
96

97. B) Individuals with acute respiratory illness of any
degree of severity who, within 14 days before onset
of illness, were in close physical contact with a
confirmed or probable case of MERS-CoV infection,
while that patient was ill.
C) For countries in the Middle East, the minimum
standard for surveillance should be testing of
patients with severe respiratory disease requiring
mechanical ventilation.
97

98. Who should be investigated?-
summarized
 SARI + PPD + either
– In a cluster (within 14/7)
– HCW exposed to pt with severe LRTI
– Traveled to middle east - 14/7
– unexpected clinical course unexplained by
current aetiology
 ARI of any severity
– close contact with confirmed/probable MERS-CoV
within 14/7
 Middle East, any ventilated pt
SARI = severe acute respiratory illness
PPD = pulmonary parenchymal disease 98

99. 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.
99 WRTHOT = without regard to history of travel

100. 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
10
0

101. )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. 10
1

102.  According to WHO , Countries in the Middle East
are strongly encouraged to consider adding
testing for MERS-CoV to current testing algorithms
as part of routine respiratory disease surveillance
and diagnostic panels for pneumonia.
 It is not necessary to wait for test results for other
pathogens before testing for MERS-CoV .
10
2

103. Treatment
 No approved virus-specific therapy at this time
 Treatment is primarily supportive and there are no
convincing data that the use of potent antiviral
agents, such as ribavirin and interferon, brings
any benefit.
 The use of steroids in high doses should be
avoided
10
3

104.  There is no specific treatment for novel coronavirus
infection , care is supportive.
 Although the patient may be suspected to have
novel coronavirus infection, administer appropriate
empiric antimicrobials as soon as possible for
community-acquired pathogens based on local
epidemiology and guidance until the diagnosis is
confirmed
10
4
Treatment

105.  No vaccine is currently available.
10
5
Vaccine availability

106. 10
6

108. How can people protect themselves
from getting MERS-CoV?
 It is not possible to give specific advice on
prevention, as neither the source of the virus nor
the mode of transmission is yet certain.
 Maintain good hand hygiene, Wash your hands
often with soap and water for 20 seconds, If soap
and water are not available, use an alcohol-
10 based hand sanitizer.
8

111.  Practise proper cough and sneeze etiquette:
Cover your mouth and nose with your arm to reduce
the spread of germs. Remember if you use a tissue,
dispose of it as soon as possible and wash your hands
afterwards.
 Avoid touching your eyes, nose, and mouth with
unwashed hands.
 Avoid close contact, when possible,with sick people.
 Clean and disinfect frequently touched surfaces, such
as toys and doorknobs.
11
1
How can people protect themselves
from getting MERS-CoV?

112. Travel measures
 WHO does not advise special screening at
points of entry nor any travel or trade
restrictions
 If travelers to the region have onset of fever with
cough or shortness of breath during their trip or within
14 days of returning , they should seek medical care.
They should tell their health-care provider about their
recent travel.

113.  Given that there have only been a relatively
small number of confirmed cases worldwide,
WHO and CDC have not issued travel health
warnings for any country related to novel
corona virus..
11
3
Travel advice to the Middle East

114. 11
4

115.  The virus that causes MERS can spread from
person to person through close contact, so
pilgrims living and traveling in crowded
conditions may be at risk.
11
5
Hajj and Umrah, 2013

116.  Because of the risk of MERS, Saudi Arabia recommends
that the following groups should postpone their plans
for Hajj and Umrah this year:
1. People over 65 years old
2. Children under 12 years old
3. Pregnant women
4. People with chronic diseases (such as heart disease,
kidney disease, diabetes, or chronic respiratory
diseases)
5. People with weakened immune systems
6. People with cancer or terminal illnesses

117.  There is a great possibility of transmitting the virus
outside Saudi Arabia? because many people are
working in Saudi Arabia, many people are
visiting Saudi Arabia for religious tourism
 Authorities should prepare for the worst and
apply standard infection control measures, just as
they did with SARS
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118.  In July 2013, the World Health Organization
(WHO) International Health Regulations
Emergency Committee determined that MERS-CoV
did not meet criteria for a "public health
emergency of international concern," but was
nevertheless of "serious and great concern"
11
8

119.  Based on the current situation and available
information, WHO encourages all Member
States to continue their surveillance for severe
acute respiratory infections (SARI) and to
carefully review any unusual patterns of
SARI or pneumonia.
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9

120.  Health care professionals are being advised to
maintain a heightened level of vigilance and pay
particular attention to travelers who have
recently returned from the Middle East and who
develop severe acute respiratory illness (SARI) ,
These people should be tested for MERS-CoV.
12
0

121. WHO recommendations
 Countries in the Middle East in particular should
maintain a high level of vigilance and a low threshold
for testing of suspect cases
 Countries, both inside and outside the region, need to
increase their levels of awareness among all people
but especially among staff working in their health
systems and to increase their levels of surveillance
about this new infection
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122.  "Health care facilities that provide care for
patients with suspected MERS-CoV infection
should take appropriate measures to decrease
the risk of transmission of the virus to other
patients and health care workers," said the CDC.
 "Health care facilities are reminded of the
importance of systematic implementation of
infection prevention and control (IPC)."
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123. Infection control
Standard precautions
+
Droplet precautions
+
Contact precautions
Airborne for aerosol generating proceedures
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3

124. 12
4

125. 12
5

126. 12
6

127. 12
7

128. 12
8

129. 12
9

131.  Practitioners and facilities should be alerted to
the possibility of MERS-CoV infection in returning
pilgrims with acute respiratory illness, especially
those with fever and cough and pulmonary
parenchymal disease (e.g. pneumonia or the
acute respiratory distress syndrome).
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1

132. 13
2

133. Panic is our enemy
Knowledge is our friend
Preparation is our best
line of defence

134. Final Messages!
“The only thing more difficult than
planning for an emergency is having
to explain why you didn’t.”
Be Proactive NOT Reactive!!!!

135. 13
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