MERS virus - no risk of epidemic
Officials mull health precautions to avoid risks:
By Dhaneshi Yatawara
Millions of people from around the world are expected to visit Mecca
over the coming months. Many will be visiting the Kingdom of Saudi
Arabia for Umrah during Ramadan which is expected to begin on July 9.
For the Muslims around the world, the fifth and last Pillar of Islam
is the Hajj pilgrimage. The Hajj is considered the culmination of each
Muslim’s religious duties and aspirations. Muslims from all over the
world seek to make the Hajj pilgrimage to the Holy City of Mecca. Yet
Saudi Arabia is facing another challenge in keeping their citizens and
all visitors healthy against the latest attack of the Middle East
Respiratory Syndrome (MERS) – a viral respiratory illness. According to
the World Health Organization, over the past 15 months, from March 2012
when the first cases happened, there have only been 77 cases. So that’s
not a lot to send a shock wave to scare the world.
Saudi Arabia has now imposed a 15-day limit for people visiting the
Kingdom to perform Umrah. According to news reports flowing from the
Middle East for the past few days, there are currently around 250,000
foreign visitors in the country and the limit has been put in place to
avoid “unbearable overcrowding” in Mecca and Medina.
The Government of Saudi Arabia emphasises that they are equipped with
excellent facilities for early diagnosis and health care, assuring
safety for pilgrims.
“Though it is called Middle Eastern Respiratory Syndrome now it has
gone beyond the Middle Eastern countries. Yet the main focus still is in
Saudi Arabia,” said Consultant Virologist of National Influenza Centre,
Medical Research Institute, Dr. Jude Jayamaha.
Dr. Jayamaha, quoting the data available so far said, out of the 77
laboratory confirmed cases worldwide about 40 were from Saudi Arabia, so
is the main attention. MERS is mainly found in Saudi Arabia, Jordan,
Qatar and United Arab Emirates. Even in the Middle East mainly patients
with identified MERS were from Saudi Arabia.
In 2012 identified cases were reported from United Kingdom, Tunisia,
Italy, Germany and France. But these were very few cases.
These belong to a type called human coronaviruses. These would
usually cause mild to moderate upper-respiratory tract illnesses, said
Dr. Jayamaha.
The WHO has instructed medical officials of every member state that
if a diagnosis of MERS–CoV infection is considered possible, apply
infection prevention and control measures recommended by WHO, or
outlined in national guidance, and refer the patient to a special
infectious disease unit for further investigation.
The world discovered human coronaviruses in the mid-1960s.
Coronavirus are named for the crown-like spikes on its surface. There
are three main sub groupings of coronaviruses, known as alpha, beta and
gamma and a fourth provisionally assigned new group called delta
coronavirus, Dr. Jayamaha said.
As the WHO explains MERS coronavirus is a beta coronavirus. It was
first reported in 2012 in Saudi Arabia and MERS-CoV used to be called
“novel coronavirus,” or “nCoV”. It is different from other coronaviruses
that have been found in people before.
“Scientists in the world still do not know what is the source or the
origin of the virus or the transmission mode of the virus. Even the
source for the SARS coronavirus was found two months after the
outbreak,” said Dr. Jayamaha.
Symptoms would be fever, cough, shortness of breath and according to
evidence available in the world scientists suspect that this illness
could be transmissible through the respiratory system. Mechanism of the
transmission is still unknown.
In all the 77 cases reported, it has been observed that the patients
had very high fever, cough and difficulty in breathing. As Dr. Jayamaha
said, the numbers are low it is very difficult to build a hypothesis
when comparing to previous outbreaks of the SARS coronavirus, measles
where millions of people were affected. “MERS virus has not shown to be
highly contagious. Measles, SARS virus and even influenza spreads much
faster than MERS virus. However, the virus has not shown to spread in a
sustained way in communities,” he said.
Up to now all patients were adults – above 40. And most of them have
had a chronic medical condition – like diabetes, coronary blocks and
chronic cardiac disease and especially chronic obstructive pulmonary
diseases such as asthma and smoking.
As per evidence available in up to date medical field, MERS is shown
to be transmitted through direct close contact.
If the pilgrims are feeling sick with fever or mild cough and cold
before setting off on the pilgrimage, it is best to postpone it for a
few days and get treated for those illnesses and start your expedition
after you have recovered, said Dr. Jayamaha. And he also said that
persons on immune-suppresent drugs, like kidney and cancer patients,
should also not travel during this time. When they are showing symptoms
they are shown as kidney failure. Though the number of MERS patients and
deaths are low and the virus is less contagious than common viruses like
influenza the WHO encourages all member states to continue their
surveillance for Severe Acute Respiratory Infections, commonly known as
SARI, in order to carefully review any unusual patterns.
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[Highlights from the World Health Organization]
All cases identified so far have had either a direct or indirect
connection with the Middle East.
Thus far, all human-to-human transmission has occurred either in a
household, work environment, or health care setting.
The specific types of exposures that result in infection are also
unknown.
MERS-CoV infection generally presents as pneumonia, but has also
caused kidney failure
The most common symptoms observed are fever, cough, and breathing
difficulties
Infection generally presents as pneumonia, but has also caused kidney
failure
Atypical symptoms such as diarrhoea have also been recorded in
patients with immunosuppression.
Although the source of the virus and the mechanism of transmission is
unknown, it would be prudent to try to reduce the general risk of
infection.
Advice to travellers -
• Avoiding close contact with people suffering from acute respiratory
infections.
• Frequent hand-washing, especially after direct contact with ill
people or their environment.
• Adhering to food safety and hygiene rules such as avoiding
undercooked meats, raw fruits and vegetables unless they have been
peeled, or unsafe water.
• Avoiding close contact with live farm or wild animals.
Based on the information available, 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.
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MERS cases and deaths, April 2012 – present As of July 3, 2013
Countries Cases (Deaths)
France 2 (1)
Italy 3 (0)
Jordan 2 (2)
Qatar 2 (0)
Saudi Arabia 62 (36)
Tunisia 2 (0)
United Kingdom (UK) 3 (2)
United Arab Emirates (UAE) 1 (1)
Total 77 (42)
Source – WHO / Centres for Disease Control and Prevention
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