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PostPosted: Sat Jun 13, 2015 12:31 pm 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
WHO Assessment of MERS In South Korea


PostPosted: Sat Jun 13, 2015 12:32 pm 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
High-level messages

This outbreak in the Republic of Korea, which started with the introduction of MERS-CoV infection into the country by a single infected traveller, was amplified by infection in hospitals and movement of cases within and among hospitals.
A combination of older and new cases continues to be reported, but the epidemic curve shows that the number of new cases occurring each day appears to be declining. This decline has coincided with much stronger contact tracing, monitoring and quarantine, suggesting that disease control measures are working. These measures are greatly facilitated by expanded laboratory testing. However, several weeks will be required to confirm the impact of the measures and whether the outbreak is fully controlled.
Several factors appear to have contributed to the initial spread of this virus.
The appearance of MERS-CoV was unexpected and unfamiliar to most physicians
Infection prevention and control measures in hospitals were not optimal
Extremely crowded Emergency Rooms and multi-bed rooms contributed significantly to nosocomial infection in some hospitals.
The practice of seeking care at a number of medical facilities(“doctor shopping”) may have been a contributing factor
The custom of having many friends and family members accompanying or visiting patients may have contributed to secondary spread of infection among contacts.
The rapid increase in numbers of cases has led to much speculation as to whether there may be new contributing factors to transmission. It is too early to draw definitive conclusions at this time, but certain observations can be made:
There is no strong evidence at present to suggest that the virus has changed to make the virus more transmissible.
Thus far, the epidemiological pattern of this outbreak appears similar to hospital-associated MERS-CoV outbreaks that have occurred in the Middle East. However, this Mission has not been able to determine whether environmental contamination, inadequate ventilation, or other factors have had a role in transmission of the virus in this outbreak. There is a compelling need for further investigation.
While there is no evidence at present of ongoing community transmission of MERS-CoV in the Republic of Korea, continued monitoring for this possibility is critical. Because the outbreak has been large and complex and more cases can be anticipated, the Government should remain vigilant and continue intensified disease control, surveillance, and prevention measures until the outbreak is clearly over.
High Level Recommendations for Government
Infection prevention and control measures should immediately be strengthened in all health care facilities across the country.
All patients presenting with fever or respiratory symptoms should be asked about: contact with a MERS patient; visits to a healthcare facility where a MERS patient has been treated; and history of travel to the Middle East in the 14 days before symptom onset. Any patient with positive responses should be promptly reported to public health authorities and managed as a suspected case while the diagnosis is being confirmed.
Close contacts of MERS cases should not travel during the period when they are being monitored for the development of symptoms.
Strong consideration should be given to re-opening schools, as schools have not been linked to transmission of MERS-CoV in the Republic of Korea or elsewhere.
The most important steps needed to stop further cases involve continued implementation of basic public health measures by all health authorities. These include:
early and complete identification and investigation of all contacts
robust quarantine/isolation and monitoring of all contacts and suspected cases
full implementation of infection prevention and control measures; and
prevention of travel, especially internationally, of infected persons and contacts
Local governments must be fully engaged and mobilized in the national fight against this large and complex outbreak.
In parallel with disease prevention and control measures, steps should be taken to strengthen domestic and international confidence and trust. The most important actions involve improving risk communications. The Ministry of Health and Welfare should provide regularly updated information (in Korean and English) on the epidemiological situation, investigations, and disease control measures.
Additional staff (for “surge capacity”) are urgently required for the response and to provide relief for staff already working on the outbreak.
Selected hospitals should be designated for safe triage and assessment of suspected MERS cases. This will require trained personnel, facility management, and communication with the public.
Comprehensive research studies designed to close critical gaps in knowledge, including sero-epidemiological studies, should be completed and the results widely communicated as quickly as possible.
The Republic of Korea should ensure that it is able to optimally respond to future outbreaks. In particular, it should strengthen the medical facilities needed to deal with serious infectious diseases, including increased numbers of negative-pressure isolation rooms; consider how to reduce the practice of “doctor shopping”; train more infection prevention and control specialists, infectious disease experts, laboratory scientists, epidemiologists, and risk communication experts; and invest in strengthening public health capacities and leadership, including at Korea Centers for Disease Control and Prevention (KCDC).



PostPosted: Sat Jun 13, 2015 12:36 pm 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
WHO recommends continuation of strong disease control measures to bring MERS-CoV outbreak in Republic of Korea to an end

News release

The Republic of Korea's Minister of Health and Welfare, Moon Hyungpyo, and Dr Keiji Fukuda, World Health Organization Assistant Director General, Health Security and Emergencies
MANILA, 13 JUNE 2015 - A joint mission by the World Health Organization and the Republic of Korea’s Ministry of Health and Welfare to review the outbreak of Middle East Respiratory Syndrome coronavirus (MERS CoV) in the Republic of Korea has recommended that continuing strengthening of contact tracing, monitoring and quarantine as well as expanded laboratory testing will prevent further spread of the virus.

The mission concluded that while the outbreak that began last month has been large and complex, it is showing a similar epidemiological pattern to previous hospital-associated MERS CoV outbreaks in the Middle East, which have been fully controlled by strong basic public health measures such as infection prevention and control.

“We know that there has been much anxiety about whether the virus in the Republic of Korea has increased its ability to transmit itself between humans,” says Dr Keiji Fukuda, WHO Assistant Director-General for Health Security who has co-led the mission with Dr Jong-Koo Lee, Director, Center for Global Medicine, Seoul National University. “However, based on available sequencing studies of this virus, it does not appear to have changed to make itself more transmissible.”

The mission confirmed that the virus is currently clustered around health facilities and found no evidence that it was circulating in the community. “However, continued monitoring for this is critical,” says Dr Fukuda.

The Assistant Director-General also warned that while the Korean authorities were already putting in place many of the recommendations the mission has made and that the number of new infections may be decreasing, the size and complexity of the outbreak means it will be a number of weeks before the true impact of the stronger disease control measures will be seen. “I want to strongly emphasize that we still need to wait and see before drawing firm conclusions,” he stresses.

The mission, comprised of experts in epidemiology, risk communications, virology, clinical management, infection prevention and control, as well as public health specialists, identified several reasons why the virus, which arrived in the country with a single infected traveller, was able to go on to infect large numbers of people in a relatively short time. These included:

The fact that the MERS CoV was unexpected and unfamiliar to most physicians in the Republic of Korea;
Sub-optimal prevention and control measures in some hospitals, related in part to overcrowding in emergency rooms and patients in rooms with many beds;
The possible impact of habits and customs such as so-called “doctor-shopping”, where patients seek care at a number of medical facilities, as well as visits to hospitalized patients by many friends and family members.
The mission was unable to conclude whether environmental contamination, inadequate ventilation or other factors played a role in the transmission of the virus in the outbreak, but made a number of recommendations to improve health facilities in the country to reduce the possibility of the virus being spread by these means in the future.

The most important steps recommended by the mission to stop further cases of MERS CoV in the Republic of Korea included:

Early and complete identification of all contacts;
Quarantine or isolation and monitoring of all contacts and suspected cases;
Full implementation of infection, prevention and control measures;
Prevention of travel, especially internationally, of infected persons and contacts.
There have been 138 confirmed cases of MERS CoV (including 1 confirmed case in China) reported in the current outbreak so far, with 14 deaths. The virus was first identified in Saudi Arabia in 2012 and much is still unknown about the exact routes of transmission. WHO has welcomed the Republic of Korea’s willingness to share its experience of the outbreak openly and to implement recommendations made by the mission.

High level messages - assessment and recommendations
For further information, please contact
Dr Margaret Harris
Communications Officer
Mobile: +41 796 036 224
E-mail: harrism@who.int

Ms Alison Clements-Hunt
Communications Officer
Tel (direct): +632 528 9985
Mobile: +63 920 9135092
E-mail: clementshuntal@who.int and PIO@wpro.who.int

http://www.wpro.who.int/mediacentre/rel ... 150613/en/


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