EVOLUTION OF THE SITUATION
The number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in a cluster in South Korea is still rising, albeit slower, and this continues to generate concerns about the possible impact of this outbreak on client operations in that country and of business travel to and from that country. Cases have also been diagnosed in the Philippines and continue to occur in the Middle East. This has markedly increased public awareness about this condition that has been occurring in the Middle East where it originated since 2012.
As of July 9thnd2015, the World Health Organization (WHO) has reported a total of 186 (cases including 35 deaths in South Korea since the country reported the first laboratory confirmed death on May 20th 2015.
All cases have in some way been linked to primary, secondary and in few cases tertiary contact with hospital cases. The ages range between 16 and 87, with a median of 56 years old, and 14 cases concern healthcare workers. A total of 5,586 contacts are being monitored by public health authorities, 348 in facilities and the remainder at home.
This disease, which is caused by a new variant of Coronavirus, originates from the Arabian Peninsula, where the primary case for the Korean outbreak was contaminated. Cases continue to occur in Saudi Arabia, where 3 new cases were identified between June 9 and June 12, and in the United Arab Emirates where a new case tested positive on June 14. Thailand reported a case in June and the Philippines one on July 6th. The latter does not have any nosocomial contacts and is not a health care worker, contrarily to most cases exported from the Middle East region, but had travelled to Saudi Arabia.
In total since September 2012 the WHO has been notified of 1368 case of laboratory confirmed MERS and of at least 487 deaths. Since January 1st 2015 there have been 423 cases.
KEY MESSAGES
Essentially the key messages are that the chances of contracting the disease through community exposition are almost zero and Europ Assistance does not recommend any MERS related travel restrictions to either South Korea or the Middle East.
Europ Assistance does however recommend avoiding unnecessary hospital visits at this stage in South Korea, and in the countries around the Persian Gulf. People with chronic diseases should be particularly careful and in addition to avoid contacts with cases and institutions where cases are treated avoid contact with animals and farms, and particularly with camels.
Clients operating clinics or employee healthcare facilities in those areas must have detection protocols in place, triage out people with fever and cough, and have ample personal protection equipment (PPE) for their staff.
PREVENTION
The disease is essentially transmitted by droplets (tiny drops of body fluid, usually mucous or saliva, suspended in the air, usually via coughing or sneezing) from infected patients, and can also be transmitted by contact with camel or camel meat, milk or urine.
The great majority of cases are patients or healthcare workers that have been in contact with existing cases and therefore the main precautions must be to:
- Avoid visiting affected patients or their contacts, or healthcare facilities that are treating affected patients. A list of the affected hospitals in South Korea is available on the site of the US Embassy in Seoul, as is a list of safe hospitals published by the Ministry of Health and Welfare of South Korea.
- Protect oneself from droplet exposure when people are coughing by contact avoidance, by washing hands frequently and thoroughly with soap and water (use hand sanitizer if water and soap are unavailable) and respecting cough etiquette. Wearing masks when people around you are coughing adds extra protection.
- Avoid contact with camel or camel meat, milk or urine.
- Seek medical attention immediately if cough or fever occur, always mentioning any travel near a cluster of cases or any contact with a potential case.
SYMPTOMS & MANAGEMENT
The main symptoms to worry about are cough and fever associated to potential contact with MERS-CoV cases or visits to hospitals where such cases are being treated. Shortness of breath is a potential associated feature as is diarrhea. There are no vaccines available and no specific treatment exists. The main treatment is supportive.
EBOLA EPIDEMIC
While public attention has decreased dramatically regarding this scourge that devastated three West African countries in 2014 and early 2015, it is still too early to reduce precautions. For instance Liberia which had just “celebrated” its first Ebola free month since early 2014, had just confirmed a new case on June 20th in a young patient that had died the day before. One hundred and two contacts are being followed. During the week to June 28, there were still 20 new cases reported, the same as the previous week, in Guinea and Sierra Leone, 12 in Guinea and 8 in Sierra Leone, and in the week to July 5th the total rose to 30 cases, 18 in Guinea, 3 in Liberia and 9 in Sierra Leone. These are still significant numbers. Enhanced surveillance of cases and contacts is the key to reaching the objective of 0 new cases in these two countries as well as in Liberia.
There have been two new cases reported in health workers in each of the last two weeks in Guinea. Altogether, there have been since the beginning of the epidemic 875 confirmed healthcare worker infections and 509 reported deaths.
Overall since the beginning of the epidemic there have been a total of 27573 cases reported from the three countries with high transmission, and 11246 reported deaths. The people aged 15 to 44 of both sexes are much more likely to be affected than children or older adults.