Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn?

Abstract

The Middle East Respiratory Coronavirus (MERS-CoV) was first isolated from a patient who died with severe pneumonia in June 2012. As of 19 June 2015, a total of 1,338 MERS-CoV infections have been notified to the World Health Organization (WHO). Clinical illness associated with MERS-CoV ranges from mild upper respiratory symptoms to rapidly progressive pneumonia and multi-organ failure. A significant proportion of patients present with non-respiratory symptoms such as headache, myalgia, vomiting and diarrhoea. A few potential therapeutic agents have been identified but none have been conclusively shown to be clinically effective. Human to human transmission is well documented, but the epidemic potential of MERS-CoV remains limited at present. Healthcare-associated clusters of MERS-CoV have been responsible for the majority of reported cases. The largest outbreaks have been driven by delayed diagnosis, overcrowding and poor infection control practices. However, chains of MERS-CoV transmission can be readily interrupted with implementation of appropriate control measures. As with any emerging infectious disease, guidelines for MERS-CoV case identification and surveillance evolved as new data became available. Sound clinical judgment is required to identify unusual presentations and trigger appropriate control precautions. Evidence from multiple sources implicates dromedary camels as natural hosts of MERS-CoV. Camel to human transmission has been demonstrated, but the exact mechanism of infection remains uncertain. The ubiquitously available social media have facilitated communication and networking amongst healthcare professionals and eventually proved to be important channels for presenting the public with factual material, timely updates and relevant advice.

Awareness among a Saudi Arabian university community of Middle East respiratory syndrome coronavirus following an outbreak

“…The term MERS-CoV in the original questions was replaced by "corona infection" as this is the term commonly used to refer to the syndrome in the local community. One question was developed in English and translated to Arabic using a published reference (2). The final questionnaire was reviewed for face validity by the expert panel of the research centre at the college of medicine and was pilot tested on 20 subjects from the target population, who were not included in the study.…”

“…The largest outbreaks have been linked to overcrowding, delay in diagnosis and poor infection control practices. Chains of transmission can be interrupted by the implementation of control measures (2).…”

Middle East respiratory syndrome

“…19 It is thought that dromedary camels are the primary animal host for MERS-CoV. 20 The camels may show no sign of infection, but still excrete the virus in their nasal secretions, faeces, milk, and urine. Bats are thought to be an earlier reservoir of MERS-CoV, but this is yet to be proven.…”

Isolation in real life: lessons from MERS-CoV in Thailand

“…In the era of globalization, the healthcare facility has become an important factor in infectious disease epidemics. 1,2 Because of the importance of continual vigilance in controlling infectious diseases, the preparation for early identification, isolation, and treatment of Middle East respiratory syndrome coronavirus (MERS-CoV) began immediately after the first case was reported in Saudi Arabia in 2012. 2,3 This preparation was especially important for Bumrungrad International Hospital (BIH) because it serves patients from many countries including a significant number from the Middle East.…”

“…4 Without adequate information being transmitted to isolated individuals they might have undermined our isolation practices. 2 Discussion with the quarantined individuals helped to proactively identify their needs. Solutions provided by the hospital management team for the isolated individuals included providing child care for family members and mitigating the financial impact of being unable to work.…”