World
WHO expects ‘more MERS cases’ in M.East after expat contracts disease in Abu Dhabi
The World Health Organization says it expects more cases of the potentially fatal Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to be detected in the region after a patient in Abu Dhabi tested positive for the disease.
It has been 19 months since the last known case of MERS – the predecessor to COVID-19 – was reported in the United Arab Emirates (UAE).
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The WHO said the UAE had informed the health body on July 10 that a 28-year-old man, who is not a UAE national, had tested positive in the country’s capital.
The man, in the city of Al Ain, was admitted to a hospital on June 8, the WHO said.
The man visited a private medical center multiple times between June 3 and June 7, complaining of vomiting, right flank pain, and dysuria (pain when passing urine).
On June 8, the case was presented to a government hospital with vomiting and gastrointestinal symptoms, including diarrhea, and was given an initial diagnosis of acute pancreatitis, acute kidney injury, and sepsis.
On June 13, he was in critical condition and referred to an intensive care unit (ICU) at a specialized government tertiary hospital, where he was put on mechanical ventilation. He deteriorated and a nasopharyngeal swab was collected on June 21 and tested positive for MERS by PCR on June 23 2023.
All 108 identified contacts were monitored for 14 days from the last date of exposure to the MERS patient, and no secondary case was identified. The infected individual has no family members or household contacts identified in the UAE.
Prior to this notification, the last MERS infection reported from the UAE was in November 2021.
The first laboratory-confirmed case of MERS in the UAE was in July 2013. Since then, the UAE has reported 94 cases of MERS (including this current case) and 12 associated deaths (Case Fatality Ratio (CFR): 13 percent).
The WHO said it continued monitoring the epidemiological situation and conducting risk assessments based on the latest information.
In a statement it said further cases were likely across the region.
“WHO expects that additional cases of MERS infection will be reported from the Middle East and/or other countries where MERS is circulating in dromedaries,” it said. “WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, including MERS, and to carefully review any unusual patterns.”
It said that cases will continue to be exported to other countries by individuals exposed to the virus through contact with dromedaries or their products (for example, consumption of camel’s raw milk), or in a healthcare setting.
The WHO said they were particularly interested in the last MERS case, given the individual had no contact with camels.
“Given that this latest case presents with severe disease but has no comorbidities and no exposure history to camels, camel raw products or MERS-CoV human case, it will be important to sequence the virus and conduct genomic analysis to screen for any unusual patterns,” the health body said in a statement. “The process for genomic analysis has begun. This will identify any genetic evolution of the virus and support WHO’s global risk assessment efforts.”
Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by a coronavirus called Middle East respiratory syndrome coronavirus.
First recorded in Saudi Arabia
In 2012, years before the first recorded case of COVID-19, MERS – a coronavirus-type disease from the same viral family as COVID-19 or SARS – was first recorded in Saudi Arabia and led to hundreds of deaths across the Arab world.
But the number of cases of MERS has been rapidly dwindling since the onset of the COVID-19 pandemic, the WHO said earlier this year.
Measures including requiring masks, hand hygiene, social distancing, improving indoor ventilation, stay-at-home orders and other methods used during the pandemic “are also likely to reduce opportunities for onward human-to-human transmission of MERS,” the organization added at the time.
Humans are infected with MERS from direct or indirect contact with dromedary camels which are the natural host and zoonotic source of the MERS infection.
MERS-CoV infections range from asymptomatic or mild respiratory symptoms to severe acute respiratory disease and death. A typical presentation of a person with MERS disease is fever, cough and shortness of breath.
Pneumonia is a common finding but not always present. Gastrointestinal symptoms, including diarrhea, have also been reported.
The virus appears to cause more severe disease in older people, persons with weakened immune systems and those with chronic diseases such as renal disease, cancer, chronic lung disease, and diabetes. Severe illness can cause respiratory failure that requires mechanical ventilation and support in an ICU, resulting in a high-death rate.
The WHO said about 35 percent of patients with MERS have died, but this may be an overestimate of the actual mortality rate, as existing surveillance systems may miss mild cases of MERS.
No vaccine or specific treatment is currently available, although the WHO says several MERS-specific vaccines and treatments are in development.
Globally, the total number of laboratory-confirmed MERS cases reported to WHO since 2012 is 2605, including 936 associated deaths as of July 2023.
A majority of the reported cases have occurred in countries in the Arab world.
Outside of the region, there has been one large outbreak in the Republic of Korea, in May 2015, during which 186 laboratory-confirmed cases (185 in the Republic of Korea and one in China) and 38 deaths were reported. The global number reflects the total number of laboratory-confirmed cases and deaths reported to WHO under IHR (2005) to date.
As a general precaution, the WHO said anyone visiting farms, markets, barns or other places where dromedaries are present should practice available hygiene measures, including regular hand washing after touching animals, avoiding touching eyes, nose or mouth with hands, and avoiding contact with sick animals.
People may also consider wearing protective gowns and gloves while professionally handling animals.
Consuming raw or undercooked animal products, including milk, meat, blood and urine, carries a high risk of infection from various organisms that might cause disease in humans. Animal products processed appropriately through proper cooking or pasteurization are safe for consumption but should also be handled carefully to avoid cross-contamination with uncooked foods.
Human-to-human transmission of MERS in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing infection, prevention and control (IPC) measures.
The WHO said strong prevention measures are critical to prevent the possible spread of MERS between people in healthcare facilities.
“Healthcare facilities should ensure environmental and engineering controls are in place, including adequate ventilation, spatial separation of at least one meter between patients and others, including health and care workers and adequate environmental cleaning,” it said.
“Healthcare workers should consistently apply standard precautions to all patients at every interaction in healthcare settings. Early identification, case management and isolation of cases, quarantine of contacts, appropriate infection prevention and control measures in health care settings, and public health awareness can prevent human-to-human transmission of MERS.’
MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and in immunocompromised persons.
Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating.
Read more:
WHO says man tests positive for MERS in UAE’s Abu Dhabi near Oman border
Saudi Arabia’s COVID-19 measures helped reduce prevalence of MERS: WHO
Possible MERS-like COVID-19 strain that could kill 1 in 3 infected people: Study