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Kamis, 08 Mei 2014


Middle East Respiratory Syndrome (MERS) 

The Middle East respiratory syndrome (MERS) coronavirus is seen in an undated transmission electron micrograph from the National Institute for Allergy and Infectious Diseases (NIAID). REUTERS/National Institute for Allergy and Infectious Diseases/Handout via Reuters

On Friday seven people were confirmed as having MERS, followed by 18 more on Saturday, the biggest daily increase in new infections so far. The total number of cases in the kingdom is 396, of whom 109 have died.
The new cases include nine in Riyadh, 10 in Jeddah, four in Mecca and two in Medina. In July many foreign pilgrims are expected to visit Mecca and Medina during Islam's fasting month of Ramadan. Millions more are expected in early October for the annual Haj.
On Friday the United States said it had discovered its first confirmed case of the disease in a man who had recently been in Saudi ArabiaEgypt said it discovered its first case, also in a man who had been in Saudi Arabia, on Thursday. 
Infections of MERS in Saudi Arabia, where it was discovered two years ago, have more than doubled since the start of April, but the total number of deaths has increased at a slower rate.
A higher number of people without symptoms are also being found with the disease, suggesting that the rapid increase in recent weeks is partly due to wider testing of people who have been in close contact with MERS patients.
MERS, a form of coronavirus like the more deadly SARS, can cause fever, coughing, shortness of breath and pneumonia. However, it is not easy to transmit between people and the World Health Organization has not advised any travel restrictions for Saudi Arabia.

Scientists say the most likely animal reservoir, from which new cases are becoming infected, is Saudi Arabia's population of camels.
Saudi Arabia has identified 18 new cases of Middle East Respiratory Syndrome (MERS), it said late on Wednesday, pushing the total number of infections in the country so far to 449.
Four people died from the disease on Wednesday, taking the total death toll in Saudi Arabiato 121 since MERS, a form of coronavirus, was identified two years ago, the Health Ministry said in a statement on its website.
The rate of infection in Saudi Arabia has surged in recent weeks after big outbreaks associated with hospitals in Jeddah and Riyadh. The total number of infections nearly doubled in April and has risen by a further 21 percent already in May.
The World Health Organisation said on Wednesday the hospital outbreaks had been partly due to "breaches" in recommended infection prevention and control measures, but added that there was no evidence of a change in the virus's ability to spread.
Scientists around the world have been searching for the animal source, or reservoir, of MERS virus infections ever since the first human cases were confirmed in September 2012.
In humans, MERS cause coughing, fever and pneumonia. Cases have so far been reported in Saudi Arabia, Qatar, Kuwait, Jordan, United Arab Emirates, Malaysia, Oman, Tunisia,FranceGermanySpainItaly and Britain.
Eight of the new cases were in Jeddah, five in the capital Riyadh, one in Najran. There were three new cases in Medina and one in Mecca, two cities that receive large influxes of Muslim pilgrims from around the country and overseas.

Half of them were in contact with people who had previously been diagnosed as having MERS, the ministry said.
When the SARS outbreak arrived in Toronto on Feb. 23, 2003, carried by a woman traveling from Hong Kong, the disease quickly spread to hospital workers and patients in area hospitals, ultimately infecting 257 individuals and killing 33 people.
It's a memory that hangs fresh in the mind of Dr Michael Bell, deputy director of the division of healthcare quality promotion at the Centers for Disease Control and Prevention. The Atlanta-based federal agency last week sent a team of infectious disease experts to Community Hospital in Munster, Indiana, to attend to the first confirmed U.S. case of Middle East Respiratory Syndrome or MERS.
"We take this very seriously," Bell told Reuters in an exclusive interview. "In a worst-case scenario, this could spread rapidly."
MERS is caused by a coronavirus, a family of viruses that includes Severe Acute Respiratory Syndrome or SARS, which emerged in China in 2002-2003 and killed some 800 people.
"If you recall the SARS experience in Toronto, that was something that managed to be transmitted into the healthcare facility, leading to severe illness and death," he said.
"This is not something that we want to take lightly."
State health officials in Indiana report the man is in good condition and improving daily. Hospital personnel who may have been exposed to the virus are being kept in home isolation and watched daily for the emergence of pneumonia-like symptoms. Generally the incubation period of MERS is 14 days.
The patient is a healthcare worker who on April 28 was admitted to the hospital just 30 minutes south of Chicago after having worked in healthcare in Saudi Arabia, the center of the MERS outbreak that began in 2012. So far, 262 people in 12 countries have had confirmed infections that have been reported by the World Health Organization, and another 100 MERS patients have been confirmed by other ministries of health. So far, 93 people have died.
U.S. health officials are now checking airline manifests and contacting patients who may have been seated near the man who took a plane from Riyadh, Saudi Arabia, to London and then to Chicago, where he then took a bus to an undisclosed city in Indiana.
To keep the infection from spreading within the hospital, the man is being treated in an isolation room from which air is expelled through a filter, preventing it from being shared in the hallway.
"It's not because we have proof that this virus spreads easily through the air, but we don't want to take any chances," Bell said.
People who enter the room wear a respirator, a type of filtering mask that keeps them from breathing in any airborne particles in the room.
And because MERS is in a family of viruses called coronaviruses that can also be spread through contact with the patient's stool, the team is taking measures to keep all possibly infectious materials from leaving the room.
"You put on gowns and gloves before you go in the room. You take them off before you leave. You pay a lot of attention to washing your hands afterwards with alcohol gel or soap and water," Bell said.
Finally, because tear ducts in the eyes are connected to the throat, healthcare workers wear goggles or face shields to prevent any droplets from entering the eyes.
All of these measures are part of standard hospital protocols for treating various infectious diseases. People with tuberculosis are placed in airborne isolation rooms. With diarrheal diseases, healthcare workers use contact prevention measures.
"None of this is different from what the hospital is already accustomed to doing. We're just making sure the implementation in this case is absolutely meticulous," Bell said.
Bell said current hospital control measures became common practice during the HIV epidemic, when hospital workers had to assume anyone coming in the doors could be infected with the virus that causes AIDS.
"I think it's safe to say every healthcare worker, even in an outpatient setting, understands that whatever comes in the doors, they could be exposed to something infectious," Bell said.
"That ranges from something as common as seasonal influenza, or, if you work in a pediatric facility, there any number of diarrheal diseases," he said.
Despite the best efforts, however, hospitals remain a major source of infection. In March, the CDC reported that roughly one of every 25 U.S. hospital patients contracts an infection during their stay.
Standard procedures for patients walking into the emergency department with a fever and respiratory complaints, as the MERS patient did in Indiana, are to put a mask on the patient and place them in room with a closed door.
"My understanding is the patient was placed in a private room very quickly," Bell said of the Indiana patient.
As for treatments, there are no specific drugs that can treat MERS, but there are basic treatments that can help the patient fight off the infection, including oxygen, which can reduce the burden on the lungs.
In addition to disease prevention experts, the CDC has sent a team of virologists to the hospital to study the MERS virus, which is still poorly understood. Although the virus first surfaced in 2012, its presence in the United States will give U.S. scientists the opportunity to study it up close.
Currently, it is not clear how the virus is transmitted, but it is clear that it can pass among individuals who have close contact with infected patients.
"The good news is that it's a group of viruses that have a very delicate envelope or membrane on the outside. Because of that, the virus tends to be rapidly inactivated by disinfectants," Bell said.
Since March of 2014, there has been a spike in the number of cases reported in Saudi Arabia. Bell said it is not clear whether that represents a change in the virus that makes it easier to spread, or an increase in the number of cases being reported to health officials.
"That is completely unknown at the moment. It's still rather early in terms of the viral characterization. Since this has all been happening outside the U.S., it's not something we've had a lot of time to work on."

At this point, the CDC has not issued any restrictions on air travel, but Bell said the case makes clear just how easily infections can spread. He recommends that people traveling through airports try to limit what they touch, and wash their hands frequently.
The first U.S. patient to test positive for the often deadly MERS virus is off supplemental oxygen and walking around his hospital room in Munster, Indiana, as health officials begin planning the man's release, state and federal authorities said on Monday.
Up to 50 hospital workers, as well as family members and close contacts of the patient who were monitored for signs of the virus have tested negative for Middle East Respiratory Syndrome.
"Every person who had contact with the index (infected) patient has been tested, and they all have tested negative," Dr Alan Kumar, chief medical information officer of Community Hospital in Munster, where the patient is being treated, told a news conference on Monday.
The U.S. Centers for Disease Control and Prevention confirmed on Friday that it had identified the first MERS case in the country, raising new concerns about the global spread of an illness with a high fatality rate and no known treatment.
The patient is a healthcare worker employed in Saudi Arabia, where the virus was first detected in 2012, who had come to Indiana to visit family. Saudi officials on Monday said the toll from a recent outbreak was still rising, with 18 new cases in the capital city of Riyadh, where the U.S. patient works.
All of the Indiana hospital employees and the patient's family members will be retested at the end of a 14-day incubation period for final confirmation they are free from MERS.
"We're being very vigilant to follow these contacts and continue to do testing on them," said Dr Daniel Feikin, a medical epidemiologist from the CDC. Feikin is overseeing the patient's care and helping track down anyone who might have had contact with him during his journey to the United States.
Since the virus first emerged, as many as 414 people have been infected with MERS, and more than a quarter have died, according to the Saudi health ministry.
According to Feikin, the Riyadh hospital where the Indiana patient works is treating MERS patients, but he was not aware of being exposed to anyone with the virus.
So far, the CDC has contacted three-fourths of the people who were in close contact with the MERS patient as he flew from Riyadh to London, and then to Chicago, before boarding a bus to Indiana. That list includes about 100 airline travelers and some 10 bus passengers.
The outbreak of an entirely new virus is worrisome because it is a coronavirus, a family of viruses that includes Severe Acute Respiratory Syndrome or SARS, which emerged in Chinain 2002-2003 and killed some 800 people.
During the SARS epidemic, a traveler from Hong Kong to Toronto caused an outbreak among hospital personnel that ultimately infected 257 individuals and killed 33 people.
When the patient in Indiana showed up with flu-like symptoms, including a fever, cough and shortness of breath, the hospital staff quickly moved him to one of its emergency department isolation rooms to prevent the spread of infection.
"The patient was always in a private room," Kumar told reporters at the briefing.
In an interview, he said the hospital used video surveillance cameras and information from RFID tracking tags - worn routinely by hospital personnel - to identify the healthcare workers who came in contact with the patient before he was placed in the isolation room.
That RFID technology, which is used to track employee movements and make sure they respond quickly to patients, allowed the hospital to record how much contact each employee had with the patient down to the minute.
Kumar said that data is giving the CDC unprecedented ability to study how much exposure to an infected individual it takes before the virus can be transmitted.
In the SARS outbreak, for example, Kumar said that exposure time was about 10 minutes before a person was at risk.
So far, there have only been about 10 cases in which a traveler has developed MERS outside of the Arabian peninsula, but Feikin said it is possible that another case could turn up in the United States.
"If this virus continues to infect people in the Middle East, it would not be surprising to have an importation at some point somewhere," he said.
Meanwhile, the presence of the virus in a patient in the United States affords the CDC the opportunity to study it and work on treatments.
Scientists are not yet sure how the MERS virus is transmitted to people, but it has been found in bats and camels, and many experts say camels are the most likely animal reservoir from which humans become infected.
"Obviously, this is our first chance to get an up close and personal look at this virus," Feiken said in an interview.
Egyptian authorities are investigating whether a 60-year-old woman who has died in the city of Port Said had the SARS-like Middle East Respiratory Syndrome (MERS). If confirmed, it would be Egypt's first death from the virus.
The woman had recently returned from an Islamic pilgrimage in Saudi Arabia, where the MERS coronavirus emerged in 2012, Helmi el-Efni, a Health Ministry official from the city on the Suez Canal, said on Monday.
The MERS coronavirus is from the same family as the SARS virus, which killed around 800 people worldwide after first appearing in China in 2002. MERS can cause coughing, fever and pneumonia.
Authorities last week reported Egypt's first MERS case, a man who had recently returned from Saudi Arabia and was being treated at a hospital in Cairo.
MERS has no vaccine or anti-viral treatment, but international and Saudi health authorities say it does not transmit easily between people and may simply die out.
Scientists say the most likely animal reservoir, from which new cases are becoming infected, is Saudi Arabia's population of camels.
Saudi Arabia has recorded 411 cases and 112 deaths so far, its Health Ministry said on Saturday.

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