ppt presentation of MERS dt 24 May 2014, for general public health education

1. MERS CoV
Dr.Sajith N Vijayan
Specialist Doctor ( Internal Medicine)
King Saud Chest Hospital, Riyadh

2. MERS-CoV
Middle East Respiratory
Syndrome - Corona Virus

3. MERS CoV: Overview
• Middle East respiratory syndrome (MERS) is a
respiratory disease caused by a newly
recognized coronavirus (MERS-CoV). It was
first reported in 2012 in Saudi Arabia

4. MERS CoV: Overview
All cases of MERS have been linked to the
Arabian Peninsula or nearby countries,
including Saudi Arabia, UAE, Qatar, Oman,
Jordan, Kuwait, Yemen, and Lebanon.

5. MERS CoV: Overview

6. MERS CoV: Overview
• Cases have been reported elsewhere,
including the United Kingdom, France, Tunisia,
Italy, Malaysia, Greece, Egypt, Turkey,
Netherlands, and the United States, with most
affected individuals having recently travelled
to the Arabian Peninsula.[

7. MERS CoV: Pathogenesis
• MERS can establish a productive infection in
monocyte-derived macrophages (MDMs) and
macrophages. This then induces a release of
proinflammatory cytokines, leading to severe
inflammation and tissue damage, which may
manifest clinically as severe pneumonia and
respiratory failure

8. MERS CoV: Pathogenesis
• Vascular endothelial cells located in the
pulmonary interstitium may also be infected
by MERS-CoV.
• MERS-CoV receptor DPP4 is expressed in
different human cells and tissues. So,
dissemination of the infection may occur.
• This may explain the increased severity and
higher fatality rate compared with the SARS-
CoV infection.

9. MERS CoV: Pathogenesis
• Cytokine-induced immune cell sequestration
• Release and induction of monocyte
chemotactic protein-1 (MCP-1) and interferon-
gamma-inducible protein-10 (IP-10), which
suppress proliferation of human myeloid
progenitor cells.

10. MERS CoV : Ethiology
• Coronaviruses are the
largest of all RNA
viruses, with single-
stranded RNA.
• They are classified into
4 genera:
*Alphacoronavirus,
*Betacoronavirus,
*Gammacoronavirus,
*Deltacoronavirus.

11. MERS CoV : Ethiology
• MERS-CoV is a newly
discovered betacoronavirus
lineage C that was first
reported in Saudi Arabia in
2012.
• The exact origin of this novel
coronavirus is still unknown.
• Early studies indicated that
MERS-CoV may be related to a
zoonotic virus found in bats.
• But more recent evidence
suggests that the virus may be
more strongly linked to camels

12. MERS CoV: Transmission
• Direct transmission through
droplets expelled during
coughs and sneezes.
• Indirect transmission
through touching surfaces
and devices contaminated
with the virus, and then
touching the mouth, nose
or eyes.
• Direct contact with patients
or infected animals or
animal products.

13. MERS CoV: Transmission
• A WHO statement in April 2014 indicated that 75% of
MERS cases reported recently appear to be
secondary cases
(ie, acquired from another infected person).

14. MERS CoV: Transmission
• The chains of transmission have not been self-
sustained, making early identification and
isolation a feasible strategy to limit the spread
of the virus

15. MERS CoV: Presentation
• The reported median incubation period (time
from infection to onset of symptoms) of Middle
East respiratory syndrome (MERS) infection is 5.2
days.
• But, periods of up to 12 days have been reported.
• Among the reported cases to date, the death rate
is 30%.
• As on 22nd May 2014, there are 554 confirmed
cases out of which, 177 passed away.

16. MERS CoV: Presentation

17. MERS CoV: Presentation
• Fatigue, and myalgias
• Fever and cough.
• Shortness of breath
• Congestion in the nose
and throat
• Diarrhea.

18. MERS CoV: Presentation
• In advanced cases, the patient can have very
serious complications such as severe
pneumonia, which may lead to death.
• Several patients with severe illness have
developed acute renal failure requiring
hemodialysis, lymphopenia,
thrombocytopenia, and/or multiorgan failure
with coagulopathy.

19. MERS CoV: Presentation
• Older age and comorbidities including
diabetes, end-stage renal disease, and chronic
cardiac and pulmonary conditions have been
associated with more severe presentation and
higher risk of mortality.

20. MERS CoV: Lab tests
• The CDC recommends collecting multiple
specimens from different sites and times in
suspected cases of Middle East respiratory
syndrome (MERS)
• Nasopharyngeal and oropharyngeal swabs,
sputum, serum, and stool/rectal swabs
• After symptom onset.

21. MERS CoV: Lab tests
• The recommended algorithm for detection of
MERS-CoV includes testing using RT-PCR
• Serology test uses indirect fluorescent
antibody (IFA) for detection of
immunoglobulin M (IgM) and immunoglobulin
G (IgG) antibodies

22. MERS: Case definition
• Patient Under Investigation (PUI)
:Category A and B
• Confirmed case
• Probable case

23. MERS: Case definition
A PATIENT UNDER INVESTIGATION (PUI)
IS A PERSON WITH THE FOLLOWING CHARACTERISTICS:
CATEGORY A
• FEVER (≥38°C, 100.4°F) AND PNEUMONIA OR ACUTE RESPIRATORY DISTRESS
SYNDROME (BASED ON CLINICAL OR RADIOLOGICAL EVIDENCE)
AND EITHER:
– A HISTORY OF TRAVEL FROM COUNTRIES IN OR NEAR THE ARABIAN PENINSULA1 WITHIN 14
DAYS BEFORE SYMPTOM ONSET
OR
– CLOSE CONTACT WITH A SYMPTOMATIC TRAVELER WHO DEVELOPED FEVER AND ACUTE
RESPIRATORY ILLNESS (NOT NECESSARILY PNEUMONIA) WITHIN 14 DAYS AFTER TRAVELING
FROM COUNTRIES IN OR NEAR THE ARABIAN PENINSULA
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, IN CONSULTATION WITH STATE AND LOCAL HEALTH
DEPARTMENTS.

24. MERS: Case definition
PUI CASE DEFINITION CONTD…......
CATEGORY B
• CLOSE CONTACT WITH A CONFIRMED OR PROBABLE CASE OF
MERS WHILE THE CASE WAS ILL
AND
– FEVER (>100°F) OR SYMPTOMS OF RESPIRATORY ILLNESS WITHIN 14
DAYS FOLLOWING THE CLOSE CONTACT
(THIS IS A LOWER THRESHOLD THAN CATEGORY A.)
PUIS SHOULD BE EVALUATED IN CONSULTATION WITH THE STATE
AND LOCAL HEALTH DEPARTMENTS.

25. MERS: Case definition
• CONFIRMED CASE
A CONFIRMED CASE IS A PERSON WITH
LABORATORY CONFIRMATION OF MERS-COV
INFECTION.
• PROBABLE CASE
A PROBABLE CASE IS A PUI: WITH ABSENT OR
INCONCLUSIVE LABORATORY RESULTS FOR MERS-
COV INFECTION: WHO IS A CLOSE CONTACT OF A
LABORATORY-CONFIRMED MERS-COV CASE.

26. MERS: Case definition
CLOSE CONTACT IS DEFINED AS:
A) ANY PERSON WHO PROVIDED CARE FOR THE
PATIENT, INCLUDING A HEALTHCARE WORKER OR
FAMILY MEMBER OR HAD SIMILARLY CLOSE
PHYSICAL CONTACT
OR
B) ANY PERSON WHO STAYED AT THE SAME PLACE (E.G.
LIVED WITH, VISITED) AS THE PATIENT WHILE THE
PATIENT WAS ILL.

27. MERS CoV: Treatment
• No antivirals are approved for the treatment
of coronavirus infection
• No vaccines are available for prevention.
• Ribavirin in combination with interferon alfa
2b under evaluation.

28. MERS CoV: Treatment
• Management of Middle East respiratory syndrome
(MERS) coronavirus (MERS-CoV) infection is
supportive this includes:
• hydration,
• antipyretic, analgesics,
• respiratory support, and
• Antibiotics - if needed for bacterial
superinfection

29. MERS CoV: Precautions
• Proper infection-control measures, including
standard contact and airborne precautions,
should be implemented while managing
patients with suspected MERS-CoV infection.

30. MERS CoV: Precautions
• Wash your hands well and
continually with water and
soap, or with other
disinfectants used for hand
washing, especially after
coughing, sneezing and
using toilets.
• Also, don't forget to wash
your hands before and after
handling or preparing foods,
and when dealing with
patients or their personal
tools.

31. MERS CoV: Precautions
• ​ Try as much as possible
to avoid touching the
eyes, nose and mouth
with your hand,
because it can transmit
the virus after touching
surfaces contaminated
with the virus.

32. Avoid as much as
possible contacting
with infected
people.
MERS CoV: Precautions

33. MERS CoV: Precautions
• Use handkerchief when
coughing or sneezing and
cover your mouth and
nose with it, then get rid
of the handkerchief in a
waste basket.
• If there are no
handkerchiefs, it is
preferred to cough or
sneeze in the top of your
arm, not in the hands
(palms).

34. MERS CoV: Precautions
• Put on face-
masks only if
you are sick or
visiting sick
patients

35. MERS CoV: Precautions
• Adhere to hygiene.​
• Clean and disinfect
frequently
touched surfaces,
such as toys and
doorknobs

36. MERS CoV: Precautions
• Pay attention to other
health habits as the
nutritional balance and
physical activity, as well
as taking enough share
of sleep, as it helps to
increase the body's
immunity

37. MERS CoV: Precautions
• Avoid raw meat and animal produce such as milk
• Based on the current medical consensus, meat
must be cooked well (including liver) before
consuming, and fresh milk to be boiled before
drinking.
• Only uncooked camel meat and raw camel milk
are potentially harmful and could harbour the
virus. Cooking the meat and drinking boiled or
pasteurized milk will make it safe to consume.

38. MERS CoV: Sick rules
• The patient can only be known that he is
infected with the disease after diagnosis at
health facilities.
• As there is no specific treatment for this
disease so far, but in general, dealing with it
ought to be in the same manner as any other
infectious respiratory diseases such as flu.

39. MERS CoV: Sick rules
• Take antipyretic and
painkillers medications.

40. MERS CoV: Sick rules
• Drink a lot of fluids
and take enough
rest and keep on
eating healthy
food.

41. MERS CoV: Sick rules
Use handkerchiefs when sneezing
and coughing
Get rid of phlegm in a safe
manner (in the trash).

42. MERS CoV: Sick rules
Cover your mouth
and nose when
you cough or
sneeze

43. MERS CoV: Sick rules
Wash your hands
regularly
Don’t share others in
their personal tools
such as towels, cups,
spoons, etc.

44. MERS CoV: Sick rules
• Reduce going outdoors unless necessary.
• You have to visit the health facility
immediately when necessary or if the
symptoms of the disease increase.

45. MERS CoV: Sick rules
• Elderly patients, health practitioners, people
in contact with camels and people of chronic
diseases or diseases affecting the immune
system, have to review the health facility
when feeling symptoms of the disease.

49. Thank You !!!