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PostPosted: Fri Apr 11, 2014 1:23 pm 
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Published Date: 2014-04-10 18:19:07
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (27): Saudi Arabia, UAE, WHO, screening
Archive Number: 20140410.2395733

MERS-COV - EASTERN MEDITERRANEAN (27): SAUDI ARABIA, UAE, WHO, MALAYSIA SCREENING
*********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Saudi Arabia, 4 cases (1 death), UAE, 1 case (1 death)
[2] Saudi Arabia (Jeddah), 3 new cases: MOH 10 Apr 2014
[3] Saudi Arabia (Jeddah), total 21 cases: media report
[4] Malaysia: medical screening pre-Hajj

******
[1] Saudi Arabia, 4 cases (1 death), UAE, 1 case (1 death)
Date: Thu 10 Apr 2014
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://who.int/csr/don/2014_04_10_mers/en/


Middle East respiratory syndrome coronavirus (MERS-CoV) -- update
-----------------------------------------------------------------
The Ministries of Health of Saudi Arabia and the United Arab Emirates (UAE) recently announced additional laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).

The 4 additional laboratory-confirmed cases reported to WHO by the Ministry of Health of Saudi Arabia on [28 Mar 2014] and [2 Apr 2014] include:
- a 26 year old man from Jeddah. He became ill on [22 Mar 2014], was hospitalised on [23 Mar 2014], and died on [6 Apr 2014].
- a 26 year old man from Jeddah. He became ill on [16 Mar 2014] and has been hospitalised since [25 Mar 2014].
- a 77 year old woman from Riyadh region. She became ill on [25 Mar 2014] and is currently in a stable condition. She is not known to have a history of exposure to animals.
- a 59 year old man from Riyadh region who became ill on [22 Mar 2014]. He is not known to have contact with animals or a known case.

The additional laboratory-confirmed case reported to WHO by the Ministry of Health of the UAE on [30 Mar 2014] was:
- a 64 year old man from Abu Dhabi with underlying medical conditions. He became ill on [21 Mar 2014], was hospitalised on [25 Mar 2014] and died on [30 Mar 2014]. He had underlying medical conditions. He did not have contact with a previously laboratory-confirmed case, but has had exposure to animals. The patient visited a camel farm in Harb city in Saudi Arabia on [10 Mar 2014] and visited Nezwa city in Oman for a day on [20 Mar 2014]. He owned an animal farm in the UAE with poultry and sheep, but had no recent visit to the farm. Investigation into the family and healthcare contacts is ongoing.

Globally, from September 2012 to date, WHO has been informed of a total of 211 laboratory-confirmed cases of infection with MERS-CoV, including 88 deaths.

WHO advice
----------
Based on the current situation and available information, WHO encourages all member states to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in healthcare facilities. Healthcare facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, healthcare workers, and visitors. Healthcare workers should be educated, trained, and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that healthcare workers apply standard precautions consistently with all patients -- regardless of their diagnosis -- in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection. Airborne precautions should be applied when performing aerosol generating procedures.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Healthcare providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All member states are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

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.

--
communicated by:
ProMED-mail rapporteurs Mary Marshall and Marianne Hopp

******
[2] Saudi Arabia (Jeddah), 3 new cases: MOH 10 Apr 2014
Date: Thu 10 Apr 2014
Source: Saudi Arabia Ministry of Health [in Arabic, machine trans., edited]
http://www.moh.gov.sa/CoronaNew/PressRe ... 0-001.aspx


MOH: 3 new cases of MERS-CoV infection in Jeddah
------------------------------------------------
In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the MERS-CoV the Ministry of Health announces the registration of 3 cases of laboratory confirmed infection with the MERS-CoV in Jeddah.

The 1st case is a 70 year old male citizen who is in intensive care.

The 2nd case is a 34 year old male citizen who is in a stable condition.

The 3rd case is a 29 year old male citizen and his condition is stable.

Note that 220 samples have been examined during the last period [time not specified, presumed since the last update], and tests showed all were negative except for the 3 cases mentioned above.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Saudi Arabia (Jeddah), total 21 cases: media report
Date: Thu 10 Apr 2014
Source: Okaz Al Youm [machine trans., edited]
http://bit.ly/1kOD7bD


MERS-CoV cases [in Jeddah] reach 21, distributed over 4 hospitals
-----------------------------------------------------------------
A medical source who declined to be named told "Okaz Today" that the number of people infected with the [MERS-CoV] at the university hospital [the King Abdul Aziz hospital] is now 9, while the number at the King Fahed Hospital is 7 cases. There are 3 cases in Al Mahjar, and 2 cases in the Armed Forces Hospital for a total of 21 cases of MERS-CoV until this moment. The source added that critical cases are being transported to ICU in the National Guard hospital.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Malaysia: medical screening pre-Hajj
Date: Thu 10 Apr 2014
Source: New Straits Times, Malaysian National News Agency (Bernama) report [edited]
http://www.nst.com.my/latest/health-scr ... n-1.560534


Would-be pilgrims, who failed health screenings by Tabung Haji (TH) [Malaysian hajj pilgrims fund board] will not be allowed to perform the hajj to prevent them from being infected by the Middle East respiratory syndrome coronavirus (MERS-CoV), which took 2 lives in Saudi Arabia to date [there have been 3 deaths reported this month, April 2014].

TH chairman Datuk Abdul Azeez Abdul Rahim said TH would take precautionary measures to combat the disease, including stationing Malaysian medical specialists to assist pilgrims there. Pilgrims found not feeling well while performing hajj would be given medical assistance, he told reporters after meeting children of a Permata Insan programme to Saudi Arabia at Seri Perdana [in Putrajaya] today [10 Apr 2014].

Also present were the prime minister's wife, Datin Seri Rosmah Mansor, who is also the patron of Permata programme, TH group managing director and board chief executive officer Datuk Paduka Ismee Ismail, Universiti Sains Islam Malaysia (USIM) vice-chancellor Prof Datuk Dr Asma Ismail, and Permata Insan director Prof Datuk Dr Mizan Adiliah Ahmad Ibrahim.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the WHO report above, it appears as though the earlier reports on cases of laboratory confirmed MERS-CoV infection in two 26 year old males in Jeddah, Saudi Arabia were in fact, 2 separate cases and not duplicate reports as suggested in prior ProMED-mail posts (MERS-CoV - Eastern Mediterranean (21): Saudi Arabia 20140328.2364957 and MERS-CoV - Eastern Mediterranean (23): Saudi Arabia 20140404.2378035). We apologize for any confusion caused by this error.

The global tally maintained by WHO for total number of laboratory confirmed cases of MERS-CoV infection as of 10 Apr 2014 is 211 including 88 deaths. According to reports on the Saudi MOH website, since 2 Apr 2014 there have been an additional 12 cases in Jeddah including 1 death (and including the 3 newly reported cases mentioned in item [2] above), and an additional 4 cases in Riyadh including 1 death. In addition there has been a media report of an announcement on the part of the UAE Ministry of Health of an additional case in Abu Dhabi (see MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763, MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, UAE, RFI 20140408.2390003, and MERS-CoV - Eastern Mediterranean (24): Saudi Arabia, RFI 20140406.2385665 for details of these cases).

If the media report in item [3] above is correct, there are an additional 7 cases of MERS-CoV in Jeddah than previously reported, as the most recent Saudi MOH reports, dated 9 Apr 2014 and 10 Apr 2014, give the total number of laboratory confirmed cases in Jeddah as 14, and the total number of laboratory confirmed cases in Saudi Arabia is listed as 182 including 67 deaths (see MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763 for details). We await further information as to the validity of this media report.

The media report from Malaysia contained in item [4] above, is the 1st report this moderator has seen where a country will be screening the health of prospective Hajjis prior to approval for attending the Hajj in an attempt to screen out identified high risk individuals with pre-existing comorbidities recognized to be risk factors for the development of severe disease with MERS-CoV infection. As a reminder, prior to the 2013 Hajj, the Saudi Arabian MOH and Hajj ministries requested that Hajj attendees self-screen and those with risk factors for severe disease with MERS-CoV were requested not to make the Hajj (see MERS-CoV - Eastern Mediterranean (43): UAE, WHO, Saudi Haj recs. 20130714.1823927).

For a map of the region showing Saudi Arabia and the UAE, see http://healthmap.org/promed/p/131. - Mod.MPP]


See Also
MERS-CoV - Eastern Mediterranean (26): Saudi Arabia 20140409.2392763
MERS-CoV - Eastern Mediterranean (25): Saudi Arabia, UAE, RFI 20140408.2390003
MERS-CoV - Eastern Mediterranean (24): Saudi Arabia, RFI 20140406.2385665
MERS-CoV - Eastern Mediterranean (23): Saudi Arabia 20140404.2378035
MERS-CoV - Eastern Mediterranean (22): UAE, WHO 20140401.2373381
MERS-CoV - Eastern Mediterranean (18): Saudi Arabia 20140321.2347610
MERS-CoV - Eastern Mediterranean (17): Kuwait, UAE, Saudi Arabia, WHO, RFI 20140320.2345849
MERS-CoV - Eastern Mediterranean (16): Saudi Arabia, WHO 20140318.2340740
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, WHO, RFI 20140317.2338519
MERS-CoV - Eastern Mediterranean (14): Saudi Arabia, RFI 20140314.2333773
MERS-CoV - Eastern Mediterranean (13): Saudi Arabia, UAE, WHO 20140313.2330878
MERS-CoV - Eastern Mediterranean (12): Saudi Arabia 20140306.2317828
MERS-CoV - Eastern Mediterranean (11): Saudi Arabia, WHO 20140301.2308415
MERS-CoV - Eastern Mediterranean (08): Saudi Arabia 20140220.2289977
MERS-CoV - Eastern Mediterranean (07): Saudi Arabia 20140215.2280653
MERS-CoV - Eastern Mediterranean (06): UAE (Abu Dhabi) 20140208.2264161
MERS-CoV - Eastern Mediterranean (05): Saudi Arabia, WHO 20140203.2252192
MERS-CoV - Eastern Mediterranean (04): Saudi Arabia, Jordan, WHO 20140128.2235722
MERS-CoV - Eastern Mediterranean (03): Oman, WHO 20140109.2162284
MERS-CoV - Eastern Mediterranean (02): animal reservoir, camel, UAE, serology 20140104.2151807
MERS-CoV - Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO 20140103.2150717
2013
---
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel, Qatar, OIE 20131231.2145606
MERS-CoV - Eastern Mediterranean (102): Dubai, fatal 20131221.2128612
MERS-CoV - Eastern Mediterranean (101): animal reservoir, camel, goat 20131219.2126531
MERS-CoV - Eastern Mediterranean (100): Saudi Arabia, WHO 20131219.2126258
MERS-CoV - Eastern Mediterranean (99): animal reservoir, camel, Qatar 20131217.2120936
MERS-CoV - Eastern Mediterranean (98): animal reserv/camel, Jordan, Saudi Arabia 20131213.2114362
MERS-CoV - Eastern Mediterranean (95): animal reservoir, camel, Qatar 20131129.2082942
MERS-CoV - Eastern Mediterranean (94): UAE (Abu Dhabi), Qatar 20131129.2082330
MERS-CoV - Eastern Mediterranean (93): animal res., camel conf, Qatar (RY) OIE 20131129.2082115
MERS-CoV - Eastern Mediterranean (91): Saudi Arabia, WHO 20131127.2078860
MERS-CoV - Eastern Mediterranean (90): Saudi Arabia, Qatar fatal 20131120.2064667
MERS-CoV - Eastern Mediterranean (88): Kuwait, WHO, Spain 20131119.2062587
MERS-CoV Eastern Mediterranean (87): animal res. camel susp. precautions 20131113.2053932
MERS-CoV - Eastern Mediterranean (86): Kuwait, 1st rep, susp, RFI 20131113.2052320
MERS-CoV - Eastern Mediterranean (85): animal reservoir, camel, susp, official 20131112.2051424
MERS-CoV - Eastern Mediterranean (84): Saudi Arabia, Oman, deaths, WHO, RFI 20131112.2049026
MERS-CoV - Eastern Mediterranean (82): Qatar, RFI 20131110.2047575
MERS-CoV - Eastern Mediterranean (81): Saudi Arabia, UAE ex Oman, RFI 20131108.2044846
MERS-CoV - Eastern Mediterranean (70): Saudi Arabia, WHO 20130913.1936342
MERS-CoV - Eastern Mediterranean (60): Qatar, new case, RFI 20130827.1904425
MERS-CoV - Eastern Mediterranean (51): Saudi Arabia, WHO, RFI 20130801.1857286
MERS-CoV - Eastern Mediterranean (40): Saudi Arabia, WHO 20130709.1813691
MERS-CoV - Eastern Mediterranean (15): Saudi Arabia, Italy ex Jordan, WHO, RFI 20130601.1749096
MERS-CoV - Eastern Mediterranean (12): Saudi Arabia, France 20130528.1741836
MERS-CoV - Eastern Mediterranean (05): Tunisia ex Saudi Arabia/Qatar, fatal, RFI 20130520.1725864
Novel coronavirus - Eastern Mediterranean (24): France, 2nd case 20130512.1707305
Novel coronavirus - Eastern Mediterranean (20): France ex UAE, WHO, Saudi Arabia 20130508.1700034
Novel coronavirus - Eastern Mediterranean (14): Germany ex UAE, WHO, fatal 20130326.1604564
Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI 20130323.1600113
Novel coronavirus - Eastern Mediterranean (11): UK, pers to pers transm 20130316.1588808
Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany 20130221.155410
Novel coronavirus - Eastern Med. (04): UK, pers to pers trans susp 20130213.1541531
Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan 20130212.1539086
2012
---
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster 20121123.1421664
Novel coronavirus - Saudi Arabia (14): KSA MOH 20121022.1358297
Novel coronavirus - Saudi Arabia (12): RFI 20121019.1353615
Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012 20120925.1308001
Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar 20120923.1305982
Novel coronavirus - Saudi Arabia (02): additional cases, RFI 20120923.1305931
Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733
.................................................mpp/mj/sh

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PostPosted: Fri Apr 11, 2014 9:16 pm 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 40249
Location: Pittsburgh, PA USA
The United Arab Emirates (UAE) today announced a cluster of Middle East respiratory syndrome coronavirus (MERS-CoV) cases in six Filipino paramedics, killing one of them, while the World Health Organization (WHO) announced an infection in a Jordanian man who had recently traveled to Saudi Arabia.

Also, late today Saudi Arabia's health ministry reported three more MERS-CoV cases from Jeddah, one of them fatal. The two survivors are both healthcare workers, according to a machine-translated statement that originally appeared in Arabic.

The paramedics worked for the same ambulance section in the city of Al Ain, according to a statement today from the UAE's interior ministry. It said the infections were detected during periodic medical exams.

The ministry said the surviving paramedics have been placed in isolation and that health officials are tracing patients transported to hospitals by the ambulance company to see if there are any other MERS-CoV infections.

UAE's six new infections boost its number of MERS-CoV cases to 27.

News of more health workers sickened by the virus stokes more concerns about their safety and questions about how the virus is spreading in medical settings. The infections in the paramedics occurred as Saudi Arabia battles a cluster of MERS-CoV infections in Jeddah, which led one of the hospitals to temporarily shutter its emergency department this week.

Jordanian case

Jordan's health ministry notified the WHO of its latest case on Apr 9, which involves a 52-year-old man with underlying medical conditions who visited Saudi Arabia between Mar 20 and Mar 29, according to a WHO statement today.

He got sick on Mar 25 and visited a hospital in Jeddah, then returned to Jordan on Mar 29, where he visited a hospital in Amman the same day and returned on Apr 2. He is listed in stable condition.

The patient is Jordan's fifth MERS case-patient.

Cluster in Jeddah

Saudi Arabia's new cases include a 45-year-old resident of Jeddah who died of his or her illness, a 28-year-old health worker, and a 25-year-old health worker, according to the health ministry statement. The new cases bring the Saudi MERS-CoV count to 185, including 68 deaths.

The new cases add to a rash of Saudi Arabian MERS-CoV infections reported over the past week, and, like the ones announced today, some of the patients have been health workers in Jeddah. The cluster of infections in Jeddah prompted King Fahd Hospital to close its emergency department for 24 hours so that it could be disinfected, according to earlier reports.

Earlier translated health ministry statements said 11 cases had recently been confirmed in Jeddah, while media reports said as many as 15 illnesses could be linked to King Fahd Hospital, including infections in three doctors and four nurses.

The WHO said since September 2012 it has received reports of 212 lab-confirmed MERS-CoV infections, 88 of them fatal. It repeated its advice to health facilities, urging them to take appropriate measures to the spread of the virus. Because it's not always possible to identify MERS-CoV patients early, health workers should apply standard precautions at all times with all patients, the WHO added.

Dispute over camels

In other developments, Saudi Arabia's agriculture minister is disputing the possible role of camels in the spread of MERS-CoV, according to Arabic media reports translated and posted by Avian Flu Diary, an infectious disease and preparedness news blog.

In a Mar 27 summary of cases and scientific reports, the WHO said camels appear to be the main source of the virus, but it's not clear how the virus is jumping from animals to people.

In addition, two genetic sequencing studies of viruses from camels found high similarity to MERS-CoV viruses that have infected people. Another study in camels and other livestock in Saudi Arabia found evidence of the virus in camels, but not goats and sheep.

A spokesman from the agriculture ministry Jaber Al-Shehri was quoted in two media sources as saying the transmission of the virus from camels to people has not been documented and that the treatment and eradication of MERS-CoV is the responsibility of the country's health ministry.

See also:

Apr 11 UAE interior ministry statement

Apr 11 WHO statement on Jordan case

Apr 11 Saudi Arabia health ministry statement

Apr 8 CIDRAP News story "Saudi hospital MERS cases prompt temporary ER closure"

Apr 11 Avian Flu Diary post

Mar 28 CIDRAP News story "WHO sees camels as MERS source, but route uncertain"

http://www.cidrap.umn.edu/news-perspect ... ore-saudis

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PostPosted: Mon Apr 14, 2014 1:10 pm 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 40249
Location: Pittsburgh, PA USA
14 April 2014 - WHO has been informed of an additional 16 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) from Saudi Arabia and the United Arab Emirates (UAE).


The 15 additional laboratory-confirmed cases, including two deaths announced on the Ministry of Health of Saudi Arabia website and provided to WHO between 6 and 11 April include:
A 70 year-old man from Jeddah with underlying medical conditions. He became ill on 24 March, was hospitalized on 29 March and died on 5 April.
A 28 year-old man from Jeddah with no reported symptom of illness. The man is a household contact of the above mentioned laboratory-confirmed case.
Three health-care workers – a 26 year-old woman, a 26 year-old man and a 33 year-old man with no symptoms of illness.
A 28 year-old man who is a health-care worker in Jeddah. He became ill on 28 March, was admitted to a hospital on 3 April and is currently receiving treatment in an intensive care unit.
A 35 year-old man from Jeddah with no reported symptom of illness.
A 32 year-old woman from Jeddah who is a health-care worker with no reported symptom of illness.
A 45 year-old man from Riyadh. He became ill on 30 March, was hospitalized on 5 April and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
A 90 year-old man from Riyadh. He became ill on 30 March, was hospitalized on 1 April, and is currently receiving treatment in an intensive care unit. He had no history of exposure to animals nor contact with a laboratory-confirmed case.
A 57 year-old man from Riyadh with underlying medical conditions. He became ill on 16 March, was admitted to a hospital on 19 March and died on 30 March.
Four men aged 29, 33, 34 and 70 years old from Jeddah.

Additionally, a previously laboratory-confirmed case has died. The concerned health authorities in Saudi Arabia are currently conducting investigations into the contacts of the cases.

The additional laboratory-confirmed case reported by the Ministry of Health of the UAE on 10 April 2014 includes:
A 45 year-old man from Abu Dhabi who became ill on 6 April, was hospitalized on 7 April and died on 10 April. The patient was not known to have any chronic disease. He did not have a recent history of travel or contact with animals or with a previously laboratory-confirmed case.

The concerned health authorities in the UAE are conducting investigations into the contacts of the case.



Globally, from September 2012 to date, WHO has been informed of a total of 228 laboratory-confirmed cases of infection with MERS-CoV, including 92 deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection. Airborne precautions should be applied when performing aerosol generating procedures.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

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.

http://www.who.int/csr/don/2014_04_14_mers/en/

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