Edisi Mac 2014

From Middle East to Malaysia

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CONTENTS
Introduction...3-4 Frequently Asked Question & Answers ..5-7 Interim Guidance For Health Profesional.8 Interim Homecare and Isolation Guidance for MERS-COv .9 Prevention Steps for Infected Person....10 Prevention Steps for Caregivers & Household...11 Hajj and Umrah .12-13 News on MERS-COv . 14-15 Tips for those visiting Middle East Countries...16

ADVISOR

CHIEF EDITOR

EDITOR

Puan Fatimah Abdullah Ketua Farmasi Farmasi

Puan Sudarwaty Abd Rajab Pegawai Farmasi U48

Puan Aziani Yacob Pegawai Farmasi U44

TEAM EDITORS
From left: Lian Ka Heng, Muhammad Qaliff Muhd Zaki, Nur Ain Mohd Tajudin, Nadwanie Harniza Ibrahim, Hanis Sadikin Abd Hadi, Ng Chun Shian, Heng Chin Yi, Moo Chee How. Not in the picture: Tinoshini A/P Silvakumer, Raja Nurul Fatin Raja Kamaruzaman

MERS-COV (Middle East Respiratory Syndrome Coronavirus), previously known as the Novel Coronavirus or SARS-like virus, is a member of the coronavirus family. It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013 MERS Coronaviruses commonly cause respiratory illness in mammals, including humans. Coronaviruses are responsible for approximately 1 in every 3 cases of the common cold. MERS-CoV is much more deadly than any coronavirus seen before.

As of 18 December 2013, eleven countries have now reported cases of human infection with MERS -CoV particularly in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates, and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases.

Common symptoms are acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms, including diarrhoea. Some patients have had kidney failure. In people with immune deficiencies, the disease may have an atypical presentation. It is important to note that the current understanding of illness caused by this infection is based on a limited number of cases and may change as we learn more about the virus.

What do you should know about MERS-CoV???

How widespread is Respiratory Syndrome Coronavirus (MERS-CoV)?
How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.

How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs -CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs -CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.

Should people avoid contact with animals or animal products?

Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided and basic hygiene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are safe for consumption but should also be handled with care, to avoid cross -contamination with uncooked foods. Other hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.

Are bats the source of the virus?

MERS-CoV has recently been found to be genetically related to a virus identified in bats from Southern Africa. But there is no definitive evidence that MERS-CoV originates in bats.

Can the MERS-CoV persist in the environment?

We do not yet know the answer to this question. Some types of environment are better suited for persistence of certain viruses but we still do not know exactly how well and under what conditions MERS -CoV may persist in the environment.

Is there a vaccine or treatment for MERS-CoV?

No. No vaccine is currently available. Treatment is largely supportive and should be based on the patients clinical condition.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between coworkers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.

Are health workers at risk from MERS-CoV?

Yes. Transmission has occurred in health-care facilities, including spread from patients to health -care providers. WHO recommends that health-care workers consistently apply appropriate infection prevention and control

Who Should Be Evaluated?

A patient under investigation (PUI) is a person with the following characteristics: fever (38C, 100.4F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence); AND EITHER history of travel from countries in or near the Arabian Peninsula1 within 14 days before symptom onset;OR close contact2 with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula;OR is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.

Clusters of Respiratory Illness in Which MERS-CoV Infection Should Be Considered

Clusters of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) should be evaluated for common respiratory pathogens. If the illnesses remain unexplained, providers should consider testing for MERS-CoV, in consultation with state and local health departments.

Reporting Patients Under Investigation (PUIs)

Healthcare professionals should immediately report to their state or local health department any person being evaluated for MERS-CoV infection as a patient under investigation (PUI). Health departments should immediately report PUIs to CDC using the MERS PUI short form provided in CDC website. Health departments should send completed investigation short forms by FAX to CDC at 770-488-7107 or attach the short form to an e-mail to eocreport@cdc.gov (subject line: MERS Patient Form).

Laboratory Testing
To date, little is known about the pathogenic potential and transmission dynamics of MERS-CoV. To increase the likelihood of detecting MERS-CoV infection, CDC recommends collecting multiple specimens from different sites at different times after symptom onset. Many state health department laboratories are approved for MERS-CoV testing using CDCs rRT-PCR assay.

Infection Control
Appropriate infection-control measures should be used while managing patients who are PUIs or who have probable or confirmed MERS-CoV infections

Management of Contacts
Healthcare professionals should carefully monitor for the appearance of fever and respiratory symptoms in any person who has had close contact2 with a confirmed case, probable case, or a PUI while the person was ill. If fever and respiratory symptoms develop within the first 14 days following the contact, the individual should be evaluated for MERS-CoV infection.

Interim Home Care and Isolation Guidance for MERS-CoV

People who are being evaluated for MERS-CoV infection and do not require hospitalization for medical reasons may be cared for and isolated in their home. Isolation is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.

Before the infected Person is Isolated at Home...you must:

Assess whether the home is suitable and appropriate for isolating the ill person.

The house should have a functioning bathroom that only the ill person and household members use.

The ill person should have his or her own bed and preferably a private room for sleeping. There should be a primary caregiver who can follow the healthcare providers instructions for medications and care.

If the home is in a multiplefamily dwelling, such as an apartment building, the area in which the ill person will stay should use a separate airventilation system, if one is present.

Basic amenities, such as heat, electricity, potable and hot water, sewer, and telephone access, should be available

Separate yourself from other people in your home As much as possible, you should stay in a different room from other people in your home. Also, you should use a separate bathroom, if available.

Call ahead before visiting your doctor

Before your medical appointment, call the healthcare provider and tell him or her that you may have

Wear a facemask You should wear a facemask when you are in the same room with other people and when you visit a healthcare provider.

Cover your coughs and sneezes Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into your sleeve.

Wash your hands Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing household items You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people in your home. After using these items, you should wash them thoroughly with soap and warm water.
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Wear a disposable facemask, gown, and gloves when you touch or have contact with the ill persons blood, body fluids and/or secretions. Have only people in the home who are essential for providing care for the ill person. Avoid sharing household items.

Keep elderly people and those who have compromised immune systems or specific health conditions Restrict visitors who do not have an essential need to be in the home.

The home have good air flow

Help the ill person follow the healthcare provider's instructions for medication

Prevention Steps for Caregivers and Household Members

Other household members should stay in another home or place of residence.

Wash your hands often and thoroughly with soap and water

Clean all high-touch surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, and

Place all used gloves, gowns, facemasks, and other contaminated items in a lined container before disposing them

Wear disposable gloves while handling soiled items.

Wash laundry thoroughly.

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Mecca, Saudi Arabia (origin of MERS): Site of annual Hajj and Umrah Overcrowding sets perfect conditions for the spread of MERS

Sites of known cases

Spreads:

By close contact By air

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Saudi Government Initiatives

Visas down by 20% per country

Health workers up by 3,000 to 22,000 total

Elderly, children, pregnant women and those with chronic medical illness were discouraged from participating in Hajj.

Saudi Arabia, Ministry of Health Guidelines

Wear facemasks Wash hand thoroughly after sneezing or coughing Use disposable tissues Avoid direct contact with infected person Avoid touching eyes, nose or mouth

Pilgrims returning from Hajj are advised to seek medical attention if they developed MERS like symptoms within 14 days after their trip.

Hajj 2013:

Number of pilgrims dropped by approximately 1 million due to MERS. No outbreak of MERS & only a handful of cases reported.

International pilgrims down by 21% Local pigrims

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News on MERS COv

New MERS virus spreads easily, deadlier than SARS

June 20, 2013. A mysterious new respiratory virus that originated in the Middle East spreads easily between people and appears more deadly than SARS. A patient who was receiving dialysis treatment spread MERS to seven others, including fellow dialysis patients at the same hospital. During SARS, such patients were known as superspreaders and effectively s e e d e d o u t b r e a k s i n n u m e r o u s c o u n t r i e s . But MERS appears far more lethal. Compared to SARS 8 percent death rate, the fatality rate for MERS in the Saudi outbreak was about 65 percent, though the experts could be missing mild cases that might skew the figures. New Straits Times

MERS virus has infected camels sin

ce 1992

els s MERS virus has been infecting cam iou ster my the say ists ent Sci 4. February 26, 201 ly went undiagnosed. ades and early human cases probab dec two st lea at for bia Ara di 2012, doctors Sau in coronavirus was first identified in me dro syn ry ato pir res t Eas e ddl ms Since the Mi en sick. MERS can cause sympto fall e hav ts ien pat ny ma how lain have struggled to exp cted more than kidney failure. To date, it has infe and ms ble pro ing ath bre er, fev including t, though infections have also spread Eas e ddl Mi the in stly mo 79, ed 180 people and kill to Europe and northern Africa.

Most MERS cases going undetected, 'slow epidemic underway': study

November 12, 2013. A new analysis of MERS case data suggests a large number of infections are going undetected, with the researchers estimating that for each case that has been found, five to 10 may have been missed. THESTAR.COM

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CAMELS carry deadly virus

February 25, 2014. In a startling revelation, researchers have found the deadly coronavirus responsible for Middle East Respiratory Syndrome (MERS) - among camels. MERS, a serious viral respiratory illness, has been identified in 182 people since 2012, according to the World Health Organisation (WHO). Nearly 79 people have died from the condition. Efforts to identify an animal source of infection have focused on bats and camels as the first known case of MERS was in a Saudi Arabian man who had four pet camels. In a study, investigators from the US and Saudi Arabia conducted a comprehensive survey of camels throughout Saudi Arabia. They collected blood samples and rectal and nasal swabs from camels, sheep and goats in November and December of 2013.Overall, 74 percent of camels sampled countrywide had antibodies to MERS-CoV. More than 80 percent of adult camels throughout the country had antibodies to the virus. The researchers also found that active virus was frequently detected in nasal swabs in 35 percent of young camels and 15 percent of adult camels countrywide. It was less frequently found in rectal swabs and not in blood, indicating that the virus most likely is spread by respiratory secretions. Malaysia Sun

TH medical team ready for MERS threat

MAKKAH: The Pilgrims Fund Board (Tabung Haji) health and medical teams here and in Medina are ready to face the Novel corona virus or Middle East Respiratory Syndrome Corona virus (MERS-CoV) pandemic. September 27, 2013. Malaysian Haj Delegation (Medical) deputy head Dr Mohamad Faid Abdul Rashid said the Tabung Haji teams were well-equipped to handle the situation, in the event of an epidemic. New Straits Times

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Tips for those visiting Middle East countries

June 8, 2013. Health Ministry director-general Datuk Dr Noor Hisham Abdullah said the disease had spread in a few countries in the Middle East and Europe. However, the World Health Organisation had not issued any travel advisory against going to the affected countries. "The ministry has outlined several precautionary measures to those who wish to visit the affected countries, especially those who will be travelling there to perform their haj or umrah." Visitors were advised to wash their hands frequently with soap and water or hand sanitisers especially after coughing, sneezing or shaking hands."Always carry a mask and hand sanitisers, and avoid eating uncooked or raw food. Make sure fruits are washed before they are eaten and drink only treated water." He said the ministry had not detected the presence of the virus in Malaysia. "Passengers arriving at the Kuala Lumpur International Airport's arrival hall will undergo a special screening process."Any cases of respiratory-related illness in the country are also closely monitored." Dr Noor Hisham added that the ministry had upgraded facilities in hospitals to accommodate patients in the event the virus had been detected. "The ministry will work closely with Lembaga Tabung Haji to monitor the health of pilgrims before, during and after their visit."The pilgrims will be briefed about MERS-CoV and the precautionary measures they will have to take." MERS-CoV is caused by the coronaviruses. The most common symptoms observed are fever, cough, shortness of breath and breathing difficulties while atypical symptoms, such as diarrhoea, have also been seen in patients with immunosuppression. New Straits Times

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