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Another MERS Import To Jordan 38M

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A new MERS case recorded in Jordan

Amman, August 26 (Petra) -- A new Middle East respiratory syndrome coronavirus (MERS-CoV) case has been recorded for a Jordanian male (38), who has recently entered the Kingdom from abroad, the Ministry of Health reported on Wednesday.

The latest case is the second in less than 24 hours.

Since 2012, 14 MERS cases have been recorded in Jordan, according to official data.

Primary Health Care Department Director in the ministry, Dr. Bashir Qasir said the patient is receiving treatment in a private hospital and his condition is critical.

Yesterday, the Ministry of Health announced that a man in his 60s, who has recently come from Saudi Arabia, was diagnosed to have the Middle East respiratory syndrome coronavirus (MERS-CoV) and he is now in critical condition //Petra// AF 
26/8/2015 - 09:13:02 PM



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Saudi Arabia's MERS burden spills over to Jordan


Issam Abo Rabia, a lab technician at the Jordanian Ministry of Heath's Central Public Lab in Amman, watches the real-time PCR monitor display results for recently-tested specimens from Jordanian patients suspected of having MERS coronavirus on August 27, 2015. 

GroundTruth Project

Amman — It wasn’t even noon yet at the Jordanian Ministry of Health’s central lab here on Thursday last week, but already the small research team was busy testing some 20 swab samples for the MERS coronavirus and fielding calls from Jordanian officials, physicians and the press.

On August 25, the lab confirmed the country’s first MERS case this year after a 60-year-old Jordanian man checked into a private hospital in Amman, complaining of some of the virus' tell-tale signs — shortness of breath and a fever.

Similar to the SARS virus, MERS is a lung infection that has affected some 1,400 people and killed more than 500 worldwide since being first identified in Saudi Arabia in 2012. Researchers believe an animal source of the virus could be dromedary camels, but it can also spread from person-to-person through close contact.

The respiratory illness came into sharp international focus after this summer's outbreak in the South Korean capital Seoul, when a local man returned from a Middle East business trip and brought with him a MERS infection that killed 36 people within three months.

Issam Abo Rabia, a lab technician at the Jordanian Ministry of Health's Central Public Lab in Amman, shows a swab sample awaiting testing for the MERS coronavirus on August 27, 2015.
Alisa Reznick

That’s why Jordan’s central lab had so many samples to test after just one positive infection — every healthcare worker, family or friend the patient came into close contact with during the last few weeks could be at risk.

Just 24 hours after the country’s first infection, another, unrelated, positive case followed — a 38-year-old Jordanian man with a travel history local officials will only describe as “abroad.” Within a week, the first man had died and the country’s caseload had risen to six, at least a few of which are the result of contact with MERS patients. 

Across Jordan’s eastern border, Saudi Arabia has reported at least one new case almost every day since August 9, most of which can be traced back to an initial outbreak in a central hospital in the country’s capital Riyadh. The identification of 13 new infections over just two days in mid-August saw the country’s number of MERS deaths top 500, according to the Ministry of Health, though those numbers differ from the World Health Organization’s global fatality count.

With six lab confirmed cases this year and 18 total since 2012, Jordan's MERS numbers pale in comparison to those figures. But making sure the situation stays that way hinges on strict adherence to a robust infection control system put in place by the country’s Ministry of Health and the central lab.

Mohammed Abdallat, the ministry’s director of communicable diseases control department, says that the first step after finding a positive result is to identify people who cross paths with the patient.

“First we look for close contacts, and we use this investigation to see if there is any link between the cases,” he said. “Then we look at preexisting diagnoses, whether he came from outside Jordan, or if he went from hospital-to-hospital.”

A ministry team is sent out to understand the patient’s circumstances, including travel history, exposure to camels, and, perhaps more importantly, the people who might unknowingly have been infected.

The investigation the Jordanian team carried out for the first, 60-year-old patient rendered only five contacts, all of whose samples came out negative. But the second 38-year-old’s close contacts included some 20 people, one of whom became Jordan’s third case — a 47-year-old female family member.

Last week, the kingdom’s fourth case, a 76-year-old man from Amman confirmed late that day, was still under investigation.

But so far, Abdallat said the researchers hadn’t uncovered any history of exposure to camels, nor any worrying travel history. As with the others, Jordanian officials collected information about the man's close contacts, investigating a radius of possible impacts to test at the central lab.

The MERS virus is classified by Jordanian health officials as a Severe Acute Respiratory Infection (SARI) and is tested using a technology called real-time Polymerase Chain Reaction, or PCR.

Central Public Lab Head of PCR Unit Mahmoud Gazo stands in front of the unit's office in Amman on August 27, 2015. The central lab's PCR unit conducts all MERS tests in the country, as well testing for other ailments spanning HIV, Hepatitis and a wide array of respiratory illnesses.
Alisa Reznick

Jordanian Ministry of Health Laboratory Director Aktham Haddadin told me in addition to testing specimens for ailments spanning HIV, Hepatitis and several SARI strains, the central lab's PCR office is the landing strip for all MERS samples in the country.

“It was a national decision to test all SARI cases [for MERS],” he said. “That way we can identify the index case very soon.”

Like conventional PCR methods, the rapid test amplifies the coronavirus’ DNA so laboratories can identify it. But real-time PCR uses fluorescent dye to highlight different volumes of the virus and allows technicians to produce faster results. Using this method, Haddadin says the central lab can identify a MERS-positive specimen within four hours.

“The physicians, nurses and labs are very well trained, they collect specimens and preserve them as required and we bring them to the lab on a weekly basis,” he told me. “We do this so that if any outbreak, respiratory case or infectious disease occurs, we can detect it immediately.”

Bulked up by regular reminders about the coronavirus’ case definition and warning signs, Haddadin says MERS events like the one that began last week are controlled by the same infection control procedures in place since the H1N1 swine flu, another respiratory epidemic, rose to international attention in 2009. The repetition is part of what he thinks makes the procedure effective in addressing the MERS threat.

“It started in 2009 with H1N1,” he said. “So once you have the system you can operate with any virus — the people here have it in their blood now.”

Sharing a border with Saudi Arabia that stretches almost 500 miles, in many ways Jordan is always at risk to receive its neighbor’s viral burdens. But Abdallat says that with international travel, anyone and everyone could come down with MERS.

“We learned in South Korea that one person can infect more than 100 people,” he said. “No country is protected from this, so the most important thing is to be aware, watch for the signs, and isolate the virus.”

Alisa Reznick is reporting for The GroundTruth Project in Amman. She is part of the global health reporting team working on "The Next Outbreak," a collaboration of The GroundTruth Project and NOVA Next. 

This story is presented by The GroundTruth Project.


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