Monday, January 20, 2014

WHO Issues MERS Update: 178 Cases; 76 Deaths

Confirmed MERS cases 2012 - 2013 by month (image from WHO)
The World Health Organization released a summary and literature update on January 20 which takes a detailed look at the current MERS outbreak and the most recent infections.

WHO has confirmed 178 cases of Middle East Respiratory Syndrome so far, which includes 76 fatalities.

Notable findings include two suspected cases in Spain have been classified as 'unconfirmed' and health care facilities are the source of more than half the MERS infections to date.

Since the last report issued on November 22, 2013, 21 additional cases of MERS have been confirmed, including seven deaths, or a 33% fatality rate. That is down from 39% in November's report and 45% in a September, 2013 report.

The most recent cases include 14 from Saudi Arabia with four fatalities, six cases from the UAE with two deaths and one fatality in Oman.

The median age of infection is 52 years, which has increased slightly from the November, 2013 report which put the median age at 51, which had similarly increased from the 50 years in the September report.

MERS has not been reported in any additional countries since the November report and continue to include Jordan, Kuwait, Oman, Qatar, Saudi Arabia and the UAE. In northern Africa, Tunisia and in Europe, France, Germany, Italy and the United Kingdom.

All victims outside the Arabian Peninsula have had a direct link to the Middle East, either through recent travel to the area or close contacts of recent visitors to the area.

Testing on two women from Spain who had recently returned from Hajj in Saudi Arabia is contradictory and those cases are considered unconfirmed. These are the only reported possible infections among Hajj visitors following the annual pilgrimage to Saudi Arabia which occurs in mid-October.

Confirmed MERS cases 2012 - 2013 by country (image from WHO)
Seven of the newest victims in Saudi Arabia are considered 'sporadic' or of unknown origin. The other seven KSA cases are considered 'secondary', that is exposed from another infected human. Six of the seven secondary cases are infected health care workers who are asymptomatic (without symptoms).

More than half the confirmed MERS cases to date have occurred in health care settings, either in workers, other patients or visitors.

WHO reports 32 health care workers have been infected. Most report mild or no symptoms and were discovered through routine contact testing of confirmed MERS patients. Seven suffered severe illness and four of those passed away.

WHO reminds health care professionals to use universal precautions and infection control measures, even if the disease has not been confirmed.  If MERS is suspected, the patient should be treated as potentially infected even if initial MERS testing shows negative results.

More evidence for MERS in camels was reported during the study period, with several ill animals in Qatar and previous signs of exposure to the virus in camels from Saudi Arabia, Egypt, Jordan, Oman, UAE and the Canary Islands.

Studies showed that a MERS-like virus has been circulating in the camel population since 2003 but has only recently become transmissible to humans. The method of exposure is still unknown.

For more information, the article provides links to publications and literature providing guidance to care providers, preparedness and response in effected countries and detailed medical and case studies.

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