Between 19-22 June 2016, WHO published 3 reports on the Disease Outbreak News (DON) describing 25 cases of Middle East Respiratory Syndrome (MERS). Twenty-four of the cases were identified as having contact with a probable, single index case who was diagnosed with MERS in a hospital in Riyadh City, Riyadh Region. The 22 June 2016 DON reported that the index case had died.
Based on available information, the probable index case is a woman who presented on 10 June 2016 to the hospital with a critical health condition, not consistent with MERS symptoms. She was triaged in the emergency room of the hospital and admitted to the vascular surgery ward. Following admission the patient showed signs of respiratory illness, and MERS was suspected. The hospital diagnosed and confirmed MERS on 12 June 2016, within 48 hours of her original admission. The patient’s MERS clinical symptoms were initially masked by other predominant symptoms.
Immediately following diagnosis the Ministry of Health of Saudi Arabia dispatched a rapid response team to the hospital. The team conducted active screening and contact tracing to identify health care workers, visitors, patients and household contacts who may have been exposed to MERS by the probable index patient. In addition, other public health control measures were immediately implemented in the hospital to limit further transmission.
As of 22 June 2016 twenty-four (24) contacts have tested positive for MERS including twenty (20) healthcare contacts and three (3) household contacts. In addition, one case has been diagnosed in a household contact of a hospital patient who was diagnosed with the disease after exposure to the probable index case. Twenty (20) of the twenty-four (24) have not exhibited any MERS symptoms.
According to WHO General-Director Margaret Chan “the Kingdom of Saudi Arabia has worked to improve its response to this challenging disease, especially through infection prevention and control in health care facilitates. Diagnosis is often complicated in patients affected by multiple co-morbidities.”
Globally since September 2012 WHO has been notified of over 1,700 laboratory-confirmed cases of infection with MERS, in 27 countries, including more than 600 related deaths.
WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS in health care facilities. It is not always possible to identify patients with MERS early because like other respiratory infections, the early symptoms of MERS are non-specific. Therefore, health care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis.
Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS infection; airborne precautions should be applied when performing aerosol generating procedures.