Middle East Respiratory Syndrome (MERS) By : Javad sheykhzadeh M.D Student of MPH Tehran university of medical sciences

INTRODUCTION : Middle East Respiratory Syndrome Coronavirus (MERS-CoV), formerly called "novel coronavirus (nCoV)," was identified in 2012 in Saudi Arabia. Most people who got infected with MERS-CoV developed severe acute respiratory illness with symptoms of fever, cough, and shortness of breath. About half of them died. A small number of the reported cases had a mild respiratory illness. Investigators are trying to figure out the source of MERS-CoV and how it spreads.

This virus is different from any other coronavirus previously found in people. It is also different from the corona virus that caused SARS (Severe Acute Respiratory Syndrome) in 2003.SARS However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats.

What Are Corona viruses? Coronaviruses are named for the crown-like spikes on their surface. They are common viruses that most people get in their lifetime. These viruses usually cause mild to moderate upper-respiratory tract illnesses. Corona viruses may also infect animals. Most of these corona viruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS corona virus can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

CORONA VIRUS

WHAT IS MERS? MIDDLE EAST RESPIRATORY SYNDROME (MERS) IS A VIRAL RESPIRATORY ILLNESS. MERS IS CAUSED BY A CORONA VIRUS CALLED “MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS” (MERS-COV). CORONA VIRUS

HOW WAS THE NAME SELECTED? THE CORONA VIRUS STUDY GROUP (CSG) OF THE INTERNATIONAL COMMITTEE ON TAXONOMY OF VIRUSES (ICTV) DECIDED IN MAY 2013 TO CALL THE NOVEL CORONA VIRUS “MIDDLE EAST RESPIRATORY SYNDROME CORONA VIRUS” (MERS-COV)MIDDLE EAST RESPIRATORY SYNDROME CORONA VIRUS” (MERS-COV)

IS MERS-COV THE SAME AS THE SARS VIRUS?  NO. MERS-COV IS NOT THE SAME CORONA VIRUS THAT CAUSED SEVERE ACUTE RESPIRATORY SYNDROME (SARS) IN  HOWEVER, LIKE THE SARS VIRUS, MERS-COV IS MOST SIMILAR TO CORONA VIRUSES FOUND IN BATS.

WHAT ARE THE SYMPTOMS OF MERS? MOST PEOPLE WHO GOT INFECTED WITH MERS-COV DEVELOPED SEVERE ACUTE RESPIRATORY ILLNESS WITH SYMPTOMS OF FEVER, COUGH, AND SHORTNESS OF BREATH. ABOUT HALF OF THEM DIED. SOME PEOPLE WERE REPORTED AS HAVING A MILD RESPIRATORY ILLNESS.

DOES MERS-COV SPREAD FROM PERSON TO PERSON? MERS-COV HAS BEEN SHOWN TO SPREAD BETWEEN PEOPLE WHO ARE IN CLOSE CONTACT. TRANSMISSION FROM INFECTED PATIENTS TO HEALTHCARE PERSONNEL HAS ALSO BEEN OBSERVED. CLUSTERS OF CASES IN SEVERAL COUNTRIES ARE BEING INVESTIGATED.

WHAT IS THE SOURCE OF MERS-COV?  WE DON’T KNOW FOR CERTAIN WHERE THE VIRUS CAME FROM. HOWEVER, IT LIKELY CAME FROM AN ANIMAL SOURCE.  IN ADDITION TO HUMANS, MERS-COV HAS BEEN FOUND IN CAMELS IN QATAR AND A BAT IN SAUDI ARABIA.  CAMELS IN A FEW OTHER COUNTRIES HAVE ALSO TESTED POSITIVE FOR ANTIBODIES TO MERS-COV, INDICATING THEY WERE PREVIOUSLY INFECTED WITH MERS-COV OR A CLOSELY RELATED VIRUS.  HOWEVER, WE DON’T KNOW WHETHER CAMELS ARE THE SOURCE OF THE VIRUS. MORE INFORMATION IS NEEDED TO IDENTIFY THE POSSIBLE ROLE THAT CAMELS, BATS, AND OTHER ANIMALS MAY PLAY IN THE TRANSMISSION OF MERS-COV.

CAN I STILL TRAVEL TO COUNTRIES IN THE ARABIAN PENINSULA OR NEIGHBORING COUNTRIES WHERE MERS CASES HAVE OCCURRED? YES. DOES NOT RECOMMEND THAT ANYONE CHANGE THEIR TRAVEL PLANS BECAUSE OF MERS. BUT ADVISES TRAVELERS TO COUNTRIES IN OR NEAR THE ARABIAN PENINSULA TO FOLLOW STANDARD PRECAUTIONS, SUCH AS HAND WASHING AND AVOIDING CONTACT WITH PEOPLE WHO ARE ILL.

WHAT IF I RECENTLY TRAVELED TO COUNTRIES IN THE ARABIAN PENINSULA OR NEIGHBORING COUNTRIES AND GOT SICK? IF YOU DEVELOP A FEVER AND SYMPTOMS OF LOWER RESPIRATORY ILLNESS, SUCH AS COUGH OR SHORTNESS OF BREATH, WITHIN 14 DAYS AFTER TRAVELING FROM COUNTRIES IN THE ARABIAN PENINSULA OR NEIGHBORING COUNTRIES YOU SHOULD SEE YOUR HEALTHCARE PROVIDER AND MENTION YOUR RECENT TRAVEL.

HOW CAN I HELP PROTECT MYSELF?  WASH YOUR 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 YOUR NOSE AND MOUTH WITH A TISSUE WHEN YOU COUGH OR SNEEZE THEN THROW THE TISSUE IN THE TRASH.  AVOID TOUCHING YOUR EYES, NOSE, AND MOUTH WITH UNWASHED HANDS.  AVOID CLOSE CONTACT, SUCH AS KISSING, SHARING CUPS, OR SHARING EATING UTENSILS, WITH SICK PEOPLE.  CLEAN AND DISINFECT FREQUENTLY TOUCHED SURFACES, SUCH AS TOYS AND DOORKNOBS.

IS THERE A VACCINE?

WHAT ARE THE TREATMENTS? THERE ARE NO SPECIFIC TREATMENTS RECOMMENDED FOR ILLNESSES CAUSED BY MERS-COV. MEDICAL CARE IS SUPPORTIVE AND TO HELP RELIEVE SYMPTOMS.

IS THERE A LAB TEST? LAB TESTS (POLYMERASE CHAIN REACTION OR PCR) FOR MERS- COV ARE AVAILABLE AT STATE HEALTH DEPARTMENTS, CDC, AND SOME INTERNATIONAL LABS. OTHERWISE, MERS-COV TESTS ARE NOT ROUTINELY AVAILABLE. THERE ARE A LIMITED NUMBER OF COMMERCIAL TESTS AVAILABLE, BUT THESE ARE NOT FDA-APPROVED.

Countries With Lab-Confirmed MERS Cases: Countries in the Arabian Peninsula with Cases Saudi Arabia United Arab Emirates (UAE) Qatar Oman Jordan Kuwait Countries with Travel-associated Cases United Kingdom (UK) France Tunisia Italy Malaysia United States of America (USA)

WHAT SHOULD HEALTHCARE PROVIDERS AND HEALTH DEPARTMENTS DO? FOR RECOMMENDATIONS AND GUIDANCE ON THE CASE DEFINITIONS; INFECTION CONTROL, INCLUDING PERSONAL PROTECTIVE EQUIPMENT GUIDANCE; HOME CARE AND ISOLATION; CASE INVESTIGATION; AND SPECIMEN COLLECTION AND SHIPMENT.

How Can Travelers Protect Themselves? Taking these everyday actions can help prevent the spread of germs and protect against colds, flu, and other illnesses: Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.alcohol-based hand sanitizer

Avoid touching your eyes, nose, and mouth. Germs spread this way. Avoid close contact with sick people.

Be sure you are up-to-date with all of your shots, and if possible, see your healthcare provider at least 4–6 weeks before travel to get any additional shots. If you are sick: Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash. Avoid contact with other people to keep from infecting them.

When Should Someone See a Health Care Provider? You should see a health care provider if you develop a fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula. You should tell the health care provider about your recent travel.

recommend that travelers change their plans because of MERS : the Saudi Arabia Ministry of Health has made special recommendations for travelers to Hajj and Umrah. Because of the risk of MERS, Saudi Arabia recommends that the following groups should postpone their plans for Hajj and Umrah this year:  People over 65 years old  Children under 12 years old  Pregnant women  People with chronic diseases (such as heart disease, kidney disease, diabetes, or respiratory disease)  People with weakened immune systems  People with cancer or terminal illnesses

INTERIM GUIDANCE FOR HEALTH PROFESSIONALS HEALTHCARE PROFESSIONALS SHOULD EVALUATE PATIENTS FOR MERS-COV INFECTION IF THEY 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. THEY SHOULD ALSO EVALUATE PATIENTS FOR MERS-COV INFECTION IF THEY HAVE HAD CLOSE CONTACT WITH A SYMPTOMATIC RECENT TRAVELER FROM THIS AREA WHO HAS FEVER AND ACUTE RESPIRATORY ILLNESS. PATIENTS WHO MEET THE CRITERIA FOR APATIENT UNDER INVESTIGATION (PUI) SHOULD ALSO BE EVALUATED FOR COMMON CAUSES OF COMMUNITY-ACQUIRED PNEUMONIA. THIS EVALUATION SHOULD BE BASED ON CLINICAL PRESENTATION AND EPIDEMIOLOGIC AND SURVEILLANCE INFORMATION.PATIENT UNDER INVESTIGATION (PUI) TESTING FOR MERS-COV AND OTHER RESPIRATORY PATHOGENS CAN BE DONE SIMULTANEOUSLY. POSITIVE RESULTS FOR ANOTHER RESPIRATORY PATHOGEN SHOULD NOT NECESSARILY PRECLUDE TESTING FOR MERS-COV..

A patient under investigation (PUI) PUI is a person with :  an acute respiratory infection, which may include fever (≥38°C, 100.4°F) and cough;  AND suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiologic evidence of consolidation);  AND history of travel from countries in the Arabian Peninsula* or neighboring countries* within 14 days;*  AND not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.  Collect specimens for MERS-CoV testing from all PUIs.  REFERENCE: CENTERS FOR DISEASE CONTROL AND PREVENTIOM

WITH REGARD MAY 2014