I. What is Middle East Respiratory Syndrome (MERS)?
Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERS-CoV). The Middle East Respiratory Syndrome virus first appeared in Saudi Arabia in 2012 and has since spread throughout the Middle East and beyond, with outbreaks and medical staff infections occurring in more than 20 countries in Europe, Africa, Asia, and the Americas.
II. Camels as a possible source of human infection
Studies have shown that the Middle East respiratory syndrome coronavirus, a beta coronavirus present in bats, can also be isolated from dromedary camels in Egypt, Saudi Arabia, and other countries. Genetic sequencing analysis indicates that the virus infecting humans is closely related to the virus in camels, so camels may be a source of infection. However, what is the route of transmission of this new coronavirus to humans? There is no clear answer yet.
What are the clinical manifestations?
Most people with confirmed MERS-CoV infection will have respiratory symptoms, including fever, cough, and shortness of breath. Some people will also have myalgia, diarrhea, nausea/vomiting, and abdominal pain. Severe cases may present with severe pneumonia, acute respiratory distress syndrome, renal failure, disseminated intravascular coagulation, and pericarditis. However, there are other infected individuals who have only mild flu-like symptoms or no symptoms at all and will recover spontaneously.
People with underlying medical conditions are more likely to contract the Middle East Respiratory Syndrome coronavirus or develop severe cases. These underlying conditions include diabetes, cancer, and chronic diseases of the heart, lungs, and kidneys. Immunocompromised individuals are also at high risk of developing the disease.
IV. Higher morbidity and mortality rate than SARS
Middle East Respiratory Syndrome (MERS) is a coronavirus that is less contagious than SARS, but has a higher death rate than SARS. Since the first case was diagnosed in Saudi Arabia three years ago, more than 1,100 people have been infected worldwide, with a mortality rate of about 40 percent. About 97% of those infected are from 10 countries in the Middle East. No effective vaccine or treatment drug has been developed.
V. The possibility of a large-scale human outbreak is low
Experts warn: people of all ages can be infected, and the age range can be from less than a full year to 99 years. The incubation period for Middle East respiratory syndrome is 2 – 14 days. Although the mortality rate of Middle East Respiratory Syndrome is high, it is less contagious from person to person. There is evidence of limited human-to-human transmission among family members and health care workers who have been in close contact with cases, however, sustained transmission in the community has not been documented. Experts judge the likelihood of a large outbreak of Middle East respiratory syndrome to be low.
VI. What can health care workers do to prevent it?
Health care workers are at risk of contracting MERS-CoV. Transmission has already occurred within hospitals in some countries, including from cases to health care workers. Because it is not always possible to detect cases of MERS in the early stages of the disease or without testing, as the symptoms and other clinical manifestations of the disease are not specific, it is important for health care workers to ensure that standard protective measures are always taken when treating all patients.
1. When contact with suspected MERS patients is required, take the following precautions.
(1) Wear a medical protective mask.
(2) Wear eye protection (e.g., goggles or face shield).
(3) Wear a clean, unsterilized, long-sleeved coat and gloves (some situations require sterilized gloves).
(4) Hand hygiene disinfection is required before and after contact with the patient and his or her surroundings, and hand hygiene disinfection is required immediately after removal of personal protective equipment.
2. When there is a possibility of exposure to the patient’s respiratory aerosol, such as intubation, the following protection is recommended.
(1) Wear a particulate filter respirator, and when wearing the upper respirator, take care to check the closure.
(2) Wear eye protection (e.g., goggles or face shield).
(3) Wear a clean, unsterilized, long-sleeved coat and gloves (some situations require sterilized gloves).
(4) When large amounts of liquid are expected to penetrate the coat, impermeable protective layers are required.
(5) Operate in a room with adequate ventilation. In mechanically ventilated rooms, a device with at least 6-12 gas exchanges per hour is required; in naturally ventilated rooms, a device with at least 60 liters/second/patient is required.
(6) Limit the number of people in the room, but need to ensure the minimum support and care needs of patients.
(7) Hand hygiene disinfection is required before and after contact with patients and their surroundings, and hand hygiene disinfection is required immediately after removal of personal protective equipment.
VII. Recommendations for the general public.
There is no specific treatment or vaccine for Middle East Respiratory Syndrome, therefore, prevention is key.
People are advised to use the following preventive measures.
1. Wash your hands regularly, using soap and water for at least 20 seconds, and help children do the same. If soap and water are not available, you can use hand sanitizer containing alcohol.
2. When coughing or sneezing, cover your nose and mouth with a tissue and throw the tissue in the trash.
3.Avoid touching your eyes, nose and mouth with unwashed hands.
4.Avoid contact with patients, such as kissing or sharing teacups and utensils.
5.Clean and disinfect frequently touched surfaces, such as toys and door handles.
Eight, outbound travelers should keep in mind six prevention and control tips.
The public traveling to Middle East countries (including Saudi Arabia, Qatar, Jordan, Yemen, Oman, UAE, Kuwait, Iraq, etc.) or to countries with recent outbreaks (such as South Korea) for travel, business, labor export, and Hajj should do the following.
1. Maintain good personal hygiene and environmental sanitation; wash your hands frequently; avoid close contact with people with respiratory infection symptoms; wear a mask when going out; and avoid staying in crowded places for a long time as much as possible.
2, during travel should pay attention to maintain a balanced diet, adequate rest; pay attention to dietary hygiene; residence or travel should keep indoor or transport air circulation. The elderly and people with basic diseases should pay particular attention to their health.
3, try to avoid animal breeding, slaughtering, raw meat products trading places and wild animal habitats; avoid direct contact with animals and animal excrement.
4. Seek medical attention promptly when symptoms of respiratory tract infection appear, avoid close contact with other people as much as possible; cover your mouth and nose with tissues and towels when coughing or sneezing, and dispose of contaminated tissues properly, and wash your hands thoroughly.
5, when entering the country with fever, cough, shortness of breath, breathing difficulties and other acute respiratory symptoms, should take the initiative to declare the disease to the entry-exit inspection and quarantine agencies, and cooperate with the health and quarantine departments to carry out investigations and corresponding medical examinations.
6, within 14 days of returning to the country, if the symptoms of acute respiratory infection, should promptly seek medical attention. Take the initiative to inform the medical staff of the recent travel history and the history of exposure in the local area in order to receive timely diagnosis and treatment.