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 earlier this month.
It has been 19 months since the last known case of MERS – a viral respiratory infection caused by a coronavirus called MERS-CoV – was reported in the United Arab Emirates (UAE).
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WHO has cautioned that further cases are likely to be reported in the region.
The global health body also said that it has been monitoring the epidemiological situation related to MERS-CoV and conducting risk assessments based on the latest information.
WHO said the UAE had informed the health body on July 10 that a 28-year-old man, an expatriate, had tested positive in Abu Dhabi.
The Al Ain-resident was admitted to a hospital on June 8, WHO said. He had 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 patient was referred to a government hospital with vomiting and gastrointes-tinal symptoms, including diarrhea,. He was initially diagnosed with acute pancreatitis, acute kidney injury and sepsis.
On June 13, he was in a critical condition and referred to the intensive care unit (ICU) at a specialized government tertiary hospital, where he was put on mechanical ventilation. As his condition deteriorated further, a nasopharyngeal swab was collected on June 21 and an RT-PCR test was conducted, which returned a positive result for MERS-CoV on June 23.
All the 108 identified contacts were monitored for 14 days from the last date of exposure to the MERS-CoV patient, but no secondary case of infection was identified. No family member or household contact of the infected person has been identified in the UAE.
As a general precaution, WHO said anyone visiting farms, markets, barns or other places where dromedaries are present should practise 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 han-dling animals.
The first laboratory-confirmed case of MERS-CoV in the UAE was in July 2013. Since then, the UAE has reported 94 cases of MERS-CoV (including the current case) and 12 associated deaths, with a CFR (Case Fatality Ratio) of 13 percent.
“WHO expects that additional cases of MERS-CoV infection will be reported from the Mid-dle East and/or other countries where MERS-CoV is circulating in dromedaries,” it said. “WHO re-emphasizes the importance of strong surveillance by all member states for acute respiratory infections, including MERS-CoV, and to carefully review any unusual patterns.”
It said 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 raw camel milk) or in a health-care setting.
WHO said it was particularly interested in the last reported MERS case, given that the individual had no contact with camels.
“Given that this latest case presents with severe disease [symptoms], but has no comorbidi-ties and no exposure history to camels, raw camel products or a MERS-CoV case in a human, it will be important to sequence the virus and conduct genomic analysis to screen for any unusual patterns,” the health body further 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,” it added.
In 2012, years before the first recorded case of COVID-19, MERS – a 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.
However, 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 wearing of masks, following hand hygiene, maintaining social distanc-ing, improving indoor ventilation, stay-at-home orders and other containment methods used during the pandemic “are also likely to reduce opportunities for onward human-to-human transmission of MERS”, WHO had said at the time.
Humans are infected with MERS from direct or indirect contact with dromedary camels, the natural host and zoonotic source of 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, includ-ing diarrhea, have also been reported.
The virus appears to cause more severe disease in older people, persons with weakened im-mune 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.
WHO said about 35 percent of patients with MERS have died, but this may be an overesti-mate of the actual mortality rate, as existing surveillance systems may miss mild cases of MERS.
No vaccine or specific treatment is currently available, although WHO says several MERS-specific vaccines and treatments are in being developed.
Globally, the total number of laboratory-confirmed MERS cases reported to WHO since 2012 is 2,605, 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 la-boratory-confirmed cases and deaths reported to WHO under IHR (2005) to date.
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 un-cooked foods.
Human-to-human transmission of MERS in health-care 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 arresting the possible spread of MERS between people in health-care facilities.
“Health-care 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.
“Health-care workers should consistently apply standard precautions to all patients at every interaction in health-care 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 all play a crucial role in preventing human-to-human transmission of MERS,” WHO further said.
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
