Wednesday, September 12, 2018

PRO/AH/EDR> MERS-CoV (37): Saudi Arabia (SH), South Korea ex Kuwait, WHO

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In this update:
[1] Saudi Arabia (Ash Sharqiyah - Eastern Region), 1 new case - MOH
[2] South Korea ex Kuwait - WHO DON

[1] Saudi Arabia (Ash Sharqiyah - Eastern Region), 1 new case - MOH
Date: 12 Sep 2018
Source: Saudi MOH 12 Sep 2018 [edited]

New case
Case No. 18-1748
MERS in Hufoof city: 64-year-old male in Hufoof city,
Alahsa Region [Ash Sharqiyah - Eastern Region]
Contact with camels: Yes
Case classification: Primary, community acquired
Outcome: Hospitalized

Communicated by:

[This is now the 6th case of laboratory confirmed MERS-CoV infection
reported by Saudi Arabia since 1 Sep 2018 and the 1st case reported
from Hufoof, Ash Sharqiyah/Eastern region since 1 Aug 2018. Of the 6
cases reported, 5 were classified as primary cases with 3 of the 5
cases reported to have had contact with camels in the 14 days
preceding onset of illness (including this newly reported case today,
12 Sep 2018).

The HealthMap/ProMED map of Saudi Arabia can be found at:
A map of Saudi Arabia showing regions can be found at:
<>. - Mod.MPP]

[2] South Korea ex Kuwait - WHO DON
Date: 12 Sep 2018
Source: WHO, Emergencies preparedness, response - Disease Outbreak
News [edited]

Middle East respiratory syndrome coronavirus (MERS-CoV) infection -
Republic of Korea [12 Sep 2018]

On [8 Sep 2018], the International Health Regulations (IHR 2005)
National Focal Point (NFP) of the Republic of Korea notified WHO of a
laboratory-confirmed case of Middle East respiratory syndrome
coronavirus (MERS-CoV).

The case is a 61-year-old male Korean national who visited Kuwait on
business from [16 Aug 2018 through 6 Sep 2018]. He returned to Korea
via Dubai.

On [28 Aug 2018], while in Kuwait, he experienced diarrhoea. On [3 Sep
2018] his symptoms worsened, and he visited a local hospital in
Mangaf, Kuwait on [4 and 6 Sep 2018]. On [7 Sep 2018], he returned to
Korea and presented to a general hospital in Seoul with diarrhoea and
fever. A diagnosis of pneumonia was made, and due to his travel
history, MERS was suspected. He was immediately isolated, transferred
to the Seoul National University Hospital where he was immediately
placed in an isolation ward. The patient is currently in a stable

A sputum sample was collected and tested positive for MERS-CoV by
RT-PCR on [8 Sep 2018] at the laboratory of Seoul Provincial Institute
of Public Health and Environment. Viral isolation is being performed.

Public health response
The Ministry of Health in the Republic of Korea is closely monitoring
21 individuals who had close contact with the patient: family members,
individuals who were seated near the patient during travel, flight
attendants, close contacts while in Seoul and 4 health care workers.
All identified contacts have been placed in quarantine at home and are
currently asymptomatic; they will be monitored by local public health
centres for 14 days after exposure to the patient. In addition, up to
435 individuals, including the passengers on the flight, were or are
under passive surveillance.

Health authorities in the Republic of Korea have been in contact with
the Ministry of Health in Kuwait. The epidemiological investigation of
the patient's exposures and travel history in Kuwait is ongoing.

WHO is working with Ministry officials in the Republic of Korea,
Kuwait and United Arab Emirates and providing technical advice and
guidance for investigations in the 3 Member States to determine the
patient's movements, exposures and to minimize the occurrence of
secondary infections.

WHO risk assessment
The virus does not pass easily from person to person unless there is
close contact, such as providing unprotected care to an infected
patient. Infection with MERS-CoV can cause severe disease resulting in
high rates of morbidity and mortality. Community-acquired human
infections with MERS-CoV have occurred from direct or indirect contact
with infected dromedary camels. MERS-CoV can also transmit between
humans through unprotected contact with an infected person. So far,
the observed non-sustained human-to-human transmission has occurred
mainly in health care settings. Human-to-human transmission can be
stopped with adequate infection prevention and control measures.

The notification of a confirmed case in the Republic of Korea does not
change WHO's overall global risk assessment for MERS. As a result of
comprehensive contact tracing and testing of high risk contacts,
additional cases may be identified in relation to this one case.
Additional infections identified as part of the ongoing public health
response will not change the overall global public health risk, which
is low.

WHO expects that additional cases of MERS-CoV infection will be
reported from the Middle East and that sporadic cases will continue to
be exported to other countries by individuals who have acquired the
infection after exposure to infected animals, animal products or human
cases (for example, in a health care setting). To date, no cases have
been associated with Hajj.

WHO continues to monitor the epidemiological situation and conduct
risk assessments based on the latest available information.

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.
WHO recommends the collection of exposure information, including
recent travel history, contact with dromedary camels and visits to
health care facilities in countries where MERS-CoV is circulating.

Infection prevention and control measures are critical to prevent the
possible spread of MERS-CoV between people in health care facilities.
It is not always possible to identify patients with MERS-CoV infection
early because, like other respiratory infections, the early symptoms
of MERS are nonspecific. Therefore, health care workers should
consistently apply standard precautions 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.

Community and household awareness of MERS and MERS prevention measures
in the home may reduce household transmission and prevent community

People with underlying illness such as diabetes, renal failure,
chronic lung disease, or who are immunocompromised are considered to
be at high risk of severe disease from MERS-CoV infection. Therefore,
in addition to avoiding close contact with suspected or confirmed
human cases of the disease, people with these conditions should avoid
close contact with animals, particularly camels, when visiting 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 does not advise any screening at points of entry with regard to
this event nor does it currently recommend the application of any
travel or trade restrictions, such as quarantine or travel bans. WHO
recommends that travellers to or from Middle East be informed on
preventive measures to avoid exposure to MERS-CoV and when or where to
seek medical attention in case of respiratory or gastrointestinal
symptoms. Information can be provided via travel health clinics,
travel agencies, conveyance operators or at points of entry. WHO also
recommends that routine core capacity requirements are in place at
designated points of entry.

If a passenger on board an aircraft has symptoms suggestive of
MERS-CoV infection, the pilot should follow the International Air
Transport Association (IATA) guidelines for infection control and
notify public health authorities at the destination airport via air
traffic control, in accordance with the International Civil Aviation
Authority Procedures for Air Navigation Services - Air Traffic
Management (ICAO PANS-ATM).

As of August 2018, the total global number of laboratory-confirmed
cases of MERS-CoV reported to WHO since 2012 is 2249, including 798
MERS-CoV associated deaths. The global number reflects the total
number of laboratory-confirmed cases and deaths reported to WHO under
the IHR (2005); the total number of deaths includes the deaths that
WHO is aware of through follow up with affected Member States.

Communicated by:

[New information in the above update includes the confirmation that
this individual had contact with the health services in Kuwait twice,
on 4 and 6 Sep 2018 for a diarrheal illness. It is interesting that
the individual sought medical care in Korea upon return for a
persistent febrile diarrhea episode, yet pneumonia was diagnosed, and
MERS-CoV was tested for and was positive. The South Korean Public
Health response identified 21 individuals as having had close contact
with the patient, including family, those seated near the patient
during travel, flight attendants, other contacts in Seoul, and 4
health care workers. These 21 individuals have been put in home
quarantine. Clearly, lessons were learned from the outbreak of
MERS-CoV in 2015 so that there was identification and confirmation of
MERS-CoV infection upon initial evaluation, with rapid isolation of
the patient and identification of potential high risk close contacts
for home quarantine and close monitoring.

We look forward to results of epidemiologic investigations in Kuwait
to hopefully identify the means of transmission of the virus to this

The HealthMap/ProMED map of South Korea can be accessed at:
Kuwait: <>. - Mod.MPP]

[See Also:
MERS-CoV (36): Saudi Arabia, South Korea, contact tracing, WHO
(35): South Korea ex Kuwait
(34): Saudi Arabia (QS) clarification
(33): Saudi Arabia: (QS) RFI
(32): Saudi Arabia (QS)
(31): Saudi Arabia (RI, QS), UK (England) ex Saudi Arabia,
(30): Saudi Arabia (RI) new case
(20): Saudi Arabia (NJ) susp. family cluster
(10): Oman, Saudi Arabia, WHO
(01): Malaysia (ex KSA), Saudi Arabia, UAE (ex Oman)
MERS-CoV (77): Saudi Arabia, camels, human, epidemiology, assessment
(01): Saudi Arabia (QS, RI, MD) RFI
MERS-CoV (123): Saudi Arabia (MK, AS) new cases
(01): Oman, Saudi Arabia
MERS-COV (167): acute management and long-term survival
(01): Saudi Arabia, new cases, new death
MERS-CoV (69): Saudi Arabia, new case, RFI
(01): Bangladesh, KSA, Algeria, UAE, Iran, WHO, RFI
- Eastern Mediterranean (82): anim res, camel,
- Eastern Mediterranean (01): Saudi Arabia, UAE, Oman, WHO
MERS-CoV - Eastern Mediterranean (106): animal reservoir, camel,
Qatar, OIE
- Eastern Mediterranean: Saudi Arabia, new case, RFI
Novel coronavirus - Eastern Mediterranean (29): MERS-CoV, ICTV
Novel coronavirus - Eastern Mediterranean: bat reservoir
Novel coronavirus - Eastern Mediterranean (06): comments
Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI
Novel coronavirus - Saudi Arabia (18): WHO, new cases, cluster
Novel coronavirus - Saudi Arabia: human isolate]
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