Middle East Respiratory Syndrome Coronavirus(MERS-CoV)

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MERS-CoV Update 03 July 2013

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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) By Dr Anjum Hashmi MBBS,CCS(USA),MPH Infection Control Director Maternity & Children's Hospital Najran KSA. Transmission electron micrograph of MERS-CoV.

MERS-CoV:

MERS-CoV MERS- CoV is a novel coronavirus first identified in September 2012 by an Egyptian virologist, who isolated the previously unknown coronavirus from the lungs of a 60-year-old patient with pneumonia and renal failure. To date, the World Health Organization (WHO) has reported a total of 77 laboratory-confirmed cases of infection with MERS- CoV , including 42 deaths.

MERS-CoV:

MERS-CoV Corona viruses are named for the crown-like spikes on their surface. They are common viruses that most people get in their lifetime. These viruses usually cause mild to moderate upper-respiratory tract illnesses. The virions had infected cells in a Vero cell culture. (CDC).

MERS-CoV/SARS-CoV:

MERS-CoV/SARS-CoV MERS-CoV is different from any other corona virus previously found in people. It is also different from the corona virus that caused SARS (Severe Acute Respiratory Syndrome) in 2003. structural morphology of MERS-CoV Structural morphology of MERS-CoV (CDC)

SARS-CoV/MERS-CoV:

SARS-CoV/MERS-CoV SARS corona virus can infect people and animals, including monkeys, cats, dogs and rodents. Genetic sequencing has determined MERS-Corona viruses is most closely related to corona viruses detected in bats. MERS-Corona viruses may also infect animals. A camel was recovered of illness after contact with whom a man got MERS-CoV & died in UAE.

Mode of Transmission:

Mode of Transmission MERS-CoV was first reported in Saudi Arabia and has spread to Europe, including England, France, Germany and most recently Italy. The original source of MERS-CoV, routes of transmission to humans, and mode of human-to-human transmission have not been determined. Health officials do not know how the newly discovered MERS-CoV spreads So far, there is no reported evidence of sustained community transmission in any country.

Mode of Transmission:

Mode of Transmission All reported cases were directly or indirectly linked to one of four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates. Eight clusters of cases to date, which occurred among close contacts or in healthcare settings, provide clear evidence of human-to-human transmission of MERS-CoV, possibly involving different modes, such as droplet, airborne & contact transmission.

Sign & Symptoms:

Sign & Symptoms Most people who became infected with MERS-CoV developed severe acute respiratory illness with symptoms like Fever 38°C , 100.4°F. Cough. Shortness of breath. Some people were reported as having a mild respiratory illness. About half of them may died due to organs failure.

Surveillance of MERS-CoV :

Surveillance of MERS-CoV Investigations suggesting incubation periods for MERS-CoV may be longer than 10 days. The time period for considering MERS in persons who develop severe acute lower respiratory illness days after traveling from the Arabian Peninsula or neighboring countries has been extended from within 10 days to within 14 days of travel.

“Patient under investigation” (PUI):

“Patient under investigation” (PUI) Persons who meet the following criteria should be reported and evaluated for MERS- CoV infection: •A person with an acute respiratory infection, which may include fever (= 38°C , 100.4°F) and cough; AND •Suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation); AND •History of travel from the Arabian Peninsula or neighboring countries within 14 days; AND •Symptoms not already explained by any other infection or etiology, including clinically indicated tests for community-acquired pneumonia

Persons may be considered for evaluation for MERS-CoV infection::

Persons may be considered for evaluation for MERS- CoV infection: • Persons who develop severe acute lower respiratory illness of known etiology within 14 days after traveling from the Arabian Peninsula or neighboring countries but who do not respond to appropriate therapy; OR • Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 14 days of traveling from the Arabian Peninsula or neighboring countries.

Close Contact of MERS-CoV:

Close Contact of MERS-CoV Any person who provided care for the patient, including a healthcare worker or family member, or had similarly close physical contact. Any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.

Probable Case of MERS-CoV:

Probable Case of MERS-CoV Three combinations of clinical, epidemiological and laboratory criteria can define a probable case: 1. A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome) AND Testing for MERS-CoV is unavailable or negative on a single inadequate specimen. AND The patient has a direct epidemiologic-link with a confirmed MERS-CoV case.

Probable Case of MERS-CoV:

Probable Case of MERS-CoV 2. A person with a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome) AND An inconclusive MERS-CoV laboratory test • that is, a positive screening test without confirmation such as testing positive on a single PCR target • A serological assay considered positive by the testing laboratory. AND A resident of or traveler to Middle Eastern countries where MERS-CoV virus is believed to be circulating, in the 14 days before onset of illness.

Probable Case of MERS-CoV:

Probable Case of MERS-CoV 3. A person with an acute febrile respiratory illness of any severity AND An inconclusive MERS-CoV laboratory test • that is, a positive screening test without confirmation such as testing positive on a single PCR target • A serological assay considered positive by the testing laboratory. AND The patient has a direct epidemiologic-link with a confirmed MERS-CoV case.

Confirmed Case of MERS-CoV:

Confirmed Case of MERS-CoV A person with laboratory confirmation of infection with MERS-CoV. (Currently confirmatory testing requires molecular diagnostics including either a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second).

Laboratory Testing :

Laboratory Testing Novel Coronavirus 2012 Real-time RT-PCR Assay (NCV-2-12 rRT -PCR Assay) is used to conform MERS- CoV in respiratory, blood and stool samples. To increase the likelihood of detecting MERS- CoV , CDC recommends collection of specimens from different sites--for example, a nasopharyngeal swab and a lower respiratory tract specimen such as sputum, bronchoalveolar lavage , bronchial wash, or tracheal aspirate. Lower respiratory tract specimens should be a priority for collection and PCR testing. Stool specimens are of lower priority.

PPE used for MERS-CoV:

PPE used for MERS-CoV

Environmental Infection Control:

Environmental Infection Control

MERS-CoV Vaccine Candidate :

MERS-CoV Vaccine Candidate Novavax on June 6, 2013 announced that it had successfully produced a vaccine candidate designed to provide protection against the recently emerging Middle East Respiratory Syndrome Coronavirus (MERS- CoV ). The vaccine candidate was made using Novavax ’ nanoparticle vaccine technology, is based on the major surface spike (S) protein of MERS- CoV . Novavax believes that MERS- CoV vaccine candidate may provide a path forward for a vaccine for this emerging threat.

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