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niman

WHO Details Jordan ex-Jeddah MERS Outbreak

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WHO has provided detail on the Jordan ex-Jeddah outbreak.

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Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Jordan

Disease outbreak news 
1 September 2015

Between 26 and 28 August 2015, the National IHR Focal Point of Jordan notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. All these cases are associated with a MERS-CoV outbreak currently occurring in a hospital in Amman city.

Details of the cases

  • A 60-year-old male living in Jeddah city, Saudi Arabia travelled to Amman city, Jordan on 28 July. He developed symptoms on 31 July and, on 10 August, was admitted to hospital. The patient, who had comorbidities, was treated symptomatically and discharged on 18 August. As symptoms relapsed, on 20 August, the patient was admitted to another hospital in Amman on 23 August. He tested positive for MERS-CoV on 25 August and passed away on 27 August. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
  • A 38-year-old male from Kuwait city, Kuwait travelled to Amman city, Jordan on 7 August. He developed symptoms on 12 August and, on 17 August, was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). Since his arrival in Amman city, he frequently visited a family member at the same hospital. The patient, who has no comorbidities, has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. He tested positive for MERS-CoV on 26 August. Currently, the patient is in critical condition in ICU. Investigation of possible epidemiological links with the index case or with shared health care workers is ongoing.
  • A 76-year-old male from Amman city developed symptoms. On 16 August, due to his chronic condition, the patient was admitted to the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). He was discharged on the same day. On 20 August, the patient was admitted to the same hospital for a medical procedure for his chronic condition and, on 24 August, was discharged. On 25 August, he developed symptoms and was admitted to the same hospital. The patient tested positive for MERS-CoV on 25 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
  • A 47-year-old female from Kuwait city, Kuwait travelled to Amman city, Jordan on 15 July. She was identified through the screening of contacts of a laboratory-confirmed MERS-CoV case (case no. 2 – see above). The patient, who has no comorbidities, tested positive for MERS-CoV on 27 August. Currently, she is asymptomatic in home isolation. The patient visited her family members at the hospital where a laboratory-confirmed MERS-CoV case was hospitalized (case no. 1 – see above). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household contacts and healthcare contacts is ongoing for these cases. The National IHR Focal Point of Jordan informed the National IHR Focal Point for the Kingdom of Saudi Arabia about the index case to trace contacts in Saudi Arabia.

Globally, the WHO has been notified of 1,478 laboratory-confirmed cases of infection with MERS-CoV, including at least 516 related deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections 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. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to 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.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

Public health authorities in host countries preparing for mass gatherings should ensure that all recommendations and guidance issued by WHO with respect to MERS-CoV have been appropriately taken into consideration and made accessible to all concerned officials. Public health authorities should plan for surge capacity to ensure that visitors during the mass gathering can be accommodated by health systems.

 

http://www.who.int/csr/don/01-september-2015-mers-jordan/en/

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WHO confirms hospital MERS outbreak in Jordan

The World Health Organization (WHO) today confirmed that four of Jordan's recent MERS-CoV cases are part of hospital-linked outbreak, the third country since May to report such an outbreak, as Saudi Arabian officials announced four more cases in Riyadh.

In South Korea, where a hospital-based outbreak in May in June sickened 186 people, health officials today announced a new plan for preventing similar outbreaks in the future, with steps to discourage frequent visits among different hospitals and curb exposures among visitors.

Hospital visitors ill in Jordan

After an 8-month pause in cases, Jordan has reported six MERS-CoV (Middle East respiratory coronavirus) cases since Aug 24, according to media reports. The first involved a 60-year-old man who had traveled from Saudi Arabia, was hospitalized, and died on Aug 27 from his infection. Though details are scarce, some of the reports hinted at possible healthcare-related exposures.

In a statement today, the WHO confirmed that four cases reported from Jordan between Aug 26 and Aug 28 are part of a MERS-CoV outbreak at a hospital in Amman. The index patient, the 60-year-old man, was from Jeddah, Saudi Arabia, and had traveled to Amman on Jul 28.

His symptoms began on Jul 31, and he was hospitalized on Aug 10. The man was discharged on Aug 18, but was hospitalized at another facility 2 days later after his symptoms returned.

An investigation is still under way into how the man was exposed to the virus in the 14 days before he started having symptoms.

The second patient is a 38-year-old man from Kuwait City who traveled to Amman on Aug 7, then developed symptoms 5 days later. Media reports had said only that the man traveled "from abroad." He was hospitalized on Aug 17 in the same facility where the index case was treated. The Kuwaiti man's only other known risk factor was that after he arrived in Amman he frequently visited a family member who was being treated at the same hospital. The WHO said he is in critical condition.

The third patient is a 76-year-old man from Amman who was hospitalized three different times at the same facility at which the first patient was hospitalized for treatment of a chronic health condition. The first time (Aug 16) was for his chronic health condition, the second (Aug 20) was for a procedure related to his underlying health issue, and the third (Aug 25) was after he started having MERS-CoV symptoms, according to the WHO.

The man is in critical condition, and investigators are exploring possible links to other MERS cases or shared healthcare workers.

Meanwhile, the fourth patient is a 47-year-old woman from Kuwait City who traveled to Amman on Jul 15. As a contact of the second patient, the man from Kuwait City, the woman tested positive for MERS-CoV on screening tests. She is asymptomatic and is in home isolation. Her only other known risk factor is that she visited family members at the hospital where the index patient was being treated.

In addition to the four cases, Jordan announced two additional ones on Aug 30 and Aug 31, according to earlier media reports. One involves a 56-year-old Jordanian man who reportedly got sick with MERS-CoV after undergoing open-heart surgery. The other is a 74-year-old woman who has pre-existing medical conditions.

MERS sickens 4 more in Riyadh

In Saudi Arabia, which is experiencing an outbreak in Riyadh centered at King Abdulaziz Medical City, the country's Ministry of Health (MOH) today reported four more cases, all in the capital.

Three of the illnesses are likely linked to the hospital outbreak: One had contact with another MERS case, and contact for two patients is under review. A fourth Riyadh patient apparently didn't have contact with an earlier case. None of them are healthcare workers.

All of the patients—three men and one woman—are adults ages 31 to 51. Three are Saudi citizens and one is a foreign national. Three are hospitalized in stable condition and one is listed as critical.

The MOH said 54 people are still being treated for MERS-CoV infections, and an additional 11 patients are in home isolation.

Two more patients have recovered, raising the total since the virus was first detected in 2012 to 612.

One more patient died from MERS-CoV, a 30-year-old Saudi woman from Riyadh who had underlying medical conditions. The latest cases and death lift Saudi Arabia's totals from the disease to 1,188 cases, including 510 deaths.

New prevention steps in Korea

In the wake of a large hospital MERS outbreak in May and June that sickened 186 people, 36 of them fatally, South Korean health officials today announced a plan to better manage infectious diseases, the Korea Herald reported.

As part of the announcement, the Ministry of Health also announced administrative moves that would better position the Korea Center for Disease Control and Prevention to strengthen public health policy and form an around-the-clock emergency operations center to flag possible epidemics.

Some of the steps were aimed at unusual features that helped fuel South Korea's outbreak, such as the cultural practice of visitors caring for family members and patients visiting multiple hospitals for treatment. For example, the government said it will introduce full-time nursing care in as many hospitals as possible. Currently, South Korea has a national nursing staff shortage.

The health ministry also announced it will start charging fees to people who request to see doctors at general hospitals without referrals from physicians at smaller clinics.

Other measures included ensuring that general hospitals with 300 or more beds have negative-pressure rooms and hiring 64 more epidemiologists over the next 3 years, according to the report.

See also:

Sep 1 WHO statement

Sep 1 Saudi MOH statement

Sep 1 Korea Herald story

 

http://www.cidrap.umn.edu/news-perspective/2015/09/who-confirms-hospital-mers-outbreak-jordan

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