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World Health Organization calls MERS serious but not a global health emergency

May 15, 2014 - 12:05am

ealth officials around the world are paying more attention to a recent increase in cases of a deadly respiratory virus known as MERS. Middle East Respiratory Syndrome first emerged in the Middle East about two years ago. Since then, more than 500 cases have been confirmed and reported to the World Health Organization, including at least 145 deaths. Most of the cases have been in Saudi Arabia. Two cases have been confirmed in the United States.

Both were in healthcare workers, living and working at hospitals in Saudi Arabia. One man in Indiana has recovered and been released. Another patient is in a Florida hospital.

Here are some questions and answers about MERS.

Q: Now that there are confirmed cases in the United States, should I be worried?

A: Health officials say people aren’t likely to get infected by casual contact. The people who have gotten sick so far are healthcare workers or family members who were in close contact with the infected person. The people most at-risk people are healthcare workers. About one-fifth of reported cases worldwide have been in that group.

Q: Are these two cases in the United States linked?

A: No. But both are healthcare personnel living in Saudi Arabia and working in hospitals that were treating MERS cases.

Q: What are the symptoms of MERS?

A: MERS was first reported in Saudi Arabia in 2012. Most people infected with the virus developed severe respiratory illness with symptoms of fever, cough, and shortness of breath.

Q: How deadly is it?

A: More than 30 percent of people with MERS have died. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms or no symptoms at all. The median age of confirmed cases is 51.

Q: Has anyone who came into contact with the two U.S. patients also gotten sick?

A: No one else has gotten sick so far from the Indiana case. U.S. officials contacted people who traveled on the same flights from Riyadh through London to Chicago, and attempted to contact people who shared the same bus to Highland, Ind. The hospital also sent home about 50 employees and kept them isolated until the hospital was sure they did not have MERS.

In Florida, up to 100 people may have come into contact with the 44-year-old patient, including 20 hospital personnel at two hospitals. Two employees of Dr. P. Phillips Hospital in Orlando where the patient was admitted May 8 have flu-like symptoms and are awaiting tests to see if they have the virus.

Officials at the Centers for Disease Control and Prevention are trying to contact more than 500 people in 20 states who may have been exposed to the patient and international authorities are doing the same overseas. The man left Jiddah, Saudi Arabia, on May 1, and flew to London, then on to Boston, Atlanta and Orlando, where he is visiting family.

Q: Is it safe to go to the theme parks in Orlando?

A: Yes. The patient didn’t feel well after he arrived in Orlando and mostly stayed home with his family. Doctors said he did "not do the usual tourist activities."

Q: What is the incubation time for the virus? What’s the treatment?

A: The incubation period of the virus — the time between exposure and development of symptoms — is about five days. Most patients who have had clear-cut exposure to an infected person have become sick within five days. Health officials are using 14 days as the window, to be on the safe side. There is no vaccine or specific treatment.

Q: What is the source of the virus? What about camels?

A: Experts don’t know for sure where the virus came from. They think an animal source is most likely. In addition to humans, the virus has been found in camels in Qatar, Egypt and Saudi Arabia, and a bat in Saudi Arabia. Camels in a few other countries have also tested positive for antibodies to the virus, which indicates they were previously infected with MERS or a closely related virus.

Saudi Arabia on Sunday said people handling camels should wear masks and gloves to prevent the spread of the virus, issuing such a warning for the first time since the virus appeared in the kingdom.

The virus comes from the same family as the severe acute respiratory syndrome, or SARS, coronavirus, which killed almost 800 people worldwide in 2003.

Q: Can I still travel to countries in the Arabian Peninsula or neighboring countries where MERS cases have occurred?

A: Yes. CDC does not recommend that anyone change their travel plans because of MERS. But it does recommend that you pay attention to your health during and after your trip. Call a doctor right away if you develop fever and cough or shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula.

To protect themselves, people should wash hands often with soap and water for 20 seconds, and help young children do the same. Avoid touching eyes, nose and mouth with unwashed hands. Cover your nose and mouth with a tissue when you cough or sneeze then throw the tissue in the trash. Clean and disinfect frequently touched surfaces, such as toys and doorknobs.

Despite a rapid increase in cases of a deadly viral infection that emerged in the Middle East two years ago, the World Health Organization said the MERS outbreak is not yet a global health emergency.

In a news conference Wednesday in Geneva, the agency said a special emergency committee of health and infectious disease experts agreed that the situation has become increasingly serious and urgent. But because “there is not convincing evidence” that the disease has become more transmissible from person to person, the experts said, it does not yet meet the criteria for being declared a public health emergency of international concern, according to WHO spokesman Keiji Fukuda.

The emergency committee found that much of the recent surge in cases was from large outbreaks of MERS in hospitals in Saudi Arabia, where some emergency rooms are overcrowded and infection control and prevention were “sub-optimal.” The WHO group called for all hospitals to immediately strengthen infection prevention and control measures. Basic measures, such as washing hands and proper use of gloves and masks, would have an immediate impact on reducing the number of cases, he said.

The virus, which causes Middle East Respiratory Syndrome, or MERS, infections in people, has been confirmed in 571 cases reported to the WHO, including 171 deaths. There are two confirmed cases in the United States. One patient in Indiana has recovered. The second patient is hospitalized in Orlando, Fla. Two hospital employees who were exposed to the Florida patient have developed flulike symptoms, and one has been hospitalized.

Hospital officials said Wednesday that the two symptomatic employees have tested negative for the virus. They are awaiting test results on 18 other health care workers. Meanwhile, the patient with MERS remains in isolation but no longer has a fever.

MERS, which was first reported in Saudi Arabia in 2012, can cause severe acute respiratory illness with fever, cough and shortness of breath. More than 30 percent of known patients who have symptoms of MERS have died. The virus is from the same family of viruses as SARS, or severe acute respiratory syndrome, which killed almost 800 people worldwide after it first appeared in China in 2002.

Experts have been concerned about the spread of infection in Saudi Arabia, where most of the cases have occurred. During Ramadan in July and the hajj in October, millions of people will make pilgrimages to Saudi Arabia from around the world.

In response to repeated questions about why the committee declined to declare a global health emergency, Fukuda said: “Calling for a global emergency is a major act… . It means you will raise anxieties. You have to have really solid information this is a global emergency.”

Last week, the WHO declared the spread of polio to several countries to be a global health emergency, only the second time that the WHO has made such an announcement since rules allowing such designations were adopted by the organization in 2007.

Fukuda said the two diseases “present two different kinds of dilemmas for the world.” The spread of polio is an international public health emergency that could grow in the next few months because of the nearly three-decade effort to eradicate the crippling disease.

With MERS, “we are not in the middle of eradication of MERS,” Fukuda said. The appearance of the virus is more like some other viruses that have arisen over the past decade. Some of those, like the H7N9 bird flu virus, have the potential to cause a global outbreak because influenza viruses constantly change and could spread easily. But others have “receded into the background,” he said.

For MERS, he said, experts do not know yet “which direction [it is] going to go in.”

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