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Sunday, 7 July 2013

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MERS virus - no risk of epidemic

Officials mull health precautions to avoid risks:

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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