MERS - Are we at risk of an emerging pandemic?

Published on Monday, 16 June 2014

Published by Susann Roth on Monday, 16 June 2014

Written by Susann Roth

We are used to new pathogens from Africa’s jungles and Asia’s megacities but not so much from Middle Eastern deserts! The Middle East Respiratory Syndrome coronavirus, or MERS-CoV, (MERS) is keeping infectious diseases experts on alert lately, although the World Health Organization (WHO) hasn’t declared MERS a global emergency.   Exactly where it comes from remains a mystery, but camels are thought to be the source of many human infections. And while the number of cases are still relatively small at this point in time, health officials are concerned about the potential for the virus to spread when as many as 1.4 million Muslims descend on Saudi Arabia in October for the Hajj, the annual Islamic pilgrimage to Mecca and Medina. MERS was discovered when a 60-year-old man from Saudi Arabia died in Jeddah in June 2012 after suffering severe pneumonia and kidney failure. The virus appeared to be on the wane before April this year, but then the number of cases exploded. As of 16 May 2014, at least 614 people have fallen sick after being infected with the virus, and 184 of them have died. The cases reported in the U.S., Europe, Asia and Africa, have all involved people who live in, or had traveled to the Middle East, or who were exposed to someone who did. Contact with camels during the spring time, when females wean their young, may have contributed to the surge in new cases, which was amplified by poor infection control in hospitals.   The virus turned up in three-quarters of samples taken from camels across Saudi Arabia, according to a study published in February this year. Camel herders, and people who visited a camel farm or consumed unpasteurized camel milk, have been among those infected. The virus has also been found in bats, suggesting that they may be a natural reservoir.   MERS belongs to the same family of pathogens as the Severe Acute Respiratory Syndrome (SARS) virus, which killed about 800 people worldwide after first appearing in People’s Republic of China in 2003. It causes fever, cough and shortness of breath, leading in severe cases to respiratory failure, organ failure and death. People with weakened immune systems are more at risk. There’s no vaccine and no specific treatment.   While the number of human infections more than doubled in April and May 2014, there’s no evidence the virus has mutated into a more transmissible form, or of any sustained human-to-human transmission. Most of the cases where people passed along the disease involved family members, or healthcare workers who were exposed. The WHO has declared a global public health emergency only twice. In 2009 for the H1N1 influenza (swine flu) pandemic, and this May, when it announced that polio had rebounded after almost being eradicated. The protocol for emergency alerts was put in place after the SARS outbreak in 2003, which disrupted travel across the globe. By mid-May, this year, WHO had met to discuss MERS five times and each time decided against labeling it an emergency, largely because of its limited transmission between humans.Rather than suggest travel bans or other global measures which might raise anxieties, the agency called on Saudi Arabia to step up basic infection-control measures in hospitals —such as having staff members wash their hands between patients— and to carry out studies to figure out where the virus is coming from, how it’s transmitted, and who is at risk. Individual countries have posted their own advisories, including signs that went up at the Ninoy Aquino International Airport in Manila in the Philippines to alert arriving passengers from the Middle East about possible infection. Here in the Philippines we may be more exposed to potentially infected people, given the large number of overseas Filipino workers travelling through, or working in the Middle East —including in the health care industry— who frequently return to Manila.  As such there is a need for the authorities to be cautious and to observe incoming passengers for any possible MERS symptoms. To avoid contracting the virus here’s a checklist of things to do: •    Observe any symptoms like coughs, cold, or fever when traveling through the Middle East •    Continue to be diligent with your hygiene behavior, including washing your hands regularly, and using alcohol disinfectant •    Monitor your cough etiquette