Middle East respiratory syndrome coronavirus (MERS-CoV) – update
7 May 2014 - On 15 April 2014, the IHR National Focal Point of Yemen notified WHO of a laboratory confirmed case of MERS-CoV in a 44 year-old male residing in Shibam. The patient was diagnosed as having hepatitis B and is reported to have developed symptoms on 17 March 2014, including fever, productive cough, chills, headache, muscle aches, and shortness of breath. He was admitted to hospital on 22 March 2014 in Hadramoot Governorate, and subsequently transferred on 29 March 2014 to an intensive-care unit of a private hospital in Sanaa. He was intubated, developed renal failure, and died on 31 March 2014.
Prior to the patient's decline and subsequent death, on 31 March 2014 oropharyngeal specimens were collected from the patient and tested positive on 2 April 2014. On 24 April 2014, the specimens were sent to the United States’ Naval Medical Research Unit-3 (NAMRU-3) for external confirmation and tested positive on 5 May 2014. Oropharyngeal specimens collected from 12 contacts of the patient tested negative at NAMRU-3.
The patient was an aircraft maintenance engineer with contact among passengers at the airport where he was working. He had no history of travel during the last month of his illness and no known contact with a confirmed case. He is reported to have visited a camel farm on a weekly basis and drank fresh raw camel milk.
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.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.
It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.
Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection. Airborne precautions should be applied when performing aerosol generating procedures.
Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.
Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.