JCI Consultant Speaks on the Spread, Treatment, and Prevention of MERS
Update: South Korea has officially been declared MERS free. The announcement had not been made at the time of this article's publication.
Due to the previous presence of Middle Eastern Respiratory Syndrome (MERS) in South Korea, JCI cancelled the Seoul 2015 Practicum and Accreditation Update. JCI consultant Dr. Chinhak Chun wrote the following article to educate readers about MERS, the infection risks it poses, and strategies for the prevention and treatment of this disease.
MERS caused by a strain of coronavirus, MERS-CoV. Clinical cases of MERS range from rare asymptomatic infections or relatively mild respiratory diseases, to rapidly progressive respiratory failures leading to multi-organ failure and death. MERS was first diagnosed in 2012 in Jordan, but Saudi Arabia has reported more than 1,000 patients since 2012. In total, MERS has been reported from 24 countries. However, outside of the Arabian Peninsula where it is endemic, MERS is an imported infection transmitted by infected travelers, ex-patriots, or visitors. Regions without the indigent dromedary camels have not reported sustained community-acquired infections.
Dromedary, or single-humped, camels are the most likely reservoir of MERS-CoV in the wild. Other wild or domesticated animals do not show the evidence of infection by MERS-CoV. The exact mechanism of transmission from camels to humans is unknown.
Human infection can occur either through the transmission of the virus from camels to humans or human-to-human transmission from an infected patient. Virus-carrying droplets generated during coughing or sneezing are considered the main route of transmission, but airborne infection appears to play a role under certain conditions, especially during aerosol producing procedures or in a poorly ventilated hospital environment. Urine and feces are known to contain MERS-CoV, but their role in human-to-human transmission is not well understood.
There are two distinctive epidemiologic patterns for MERS. The first is the sporadic and community-acquired endemic infection in the Arabian Peninsula. The second is a rapidly progressive outbreak in the hospital setting by transmission from patient-to-patient, or patient-to-family, or patient-to-health care workers. The recent outbreak in South Korea was the second type. According to WHO, there is no evidence of sustained human-to-human transmission in South Korea.
Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. Centers for Disease Control and Prevention (CDC) advises the following everyday preventive actions:
Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.
Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash.
Avoid touching your eyes, nose and mouth with unwashed hands.
Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.
Clean and disinfect frequently touched surfaces and objects, such as doorknobs.
When in the regions known to have endemic MERS:
Avoid farms breeding camels or market places where camels are traded.
Avoid close contact with camels.
Avoid close contact with persons with respiratory symptoms.
If you are planning to visit a hospital in the endemic region:
Obtain information before visiting whether the hospital is treating patients with confirmed/suspected MERS or patients under investigation for MERS. If so, obtain expert advice from national or international organizations such as a ministry of health, WHO, or the CDC.
If you are caring for or living with a person confirmed to have, or being evaluated for, MERS-CoV infection, visit the CDC site for interim guidance on preventing MERS-CoV from spreading to others in houses and communities.
There is no specific antiviral treatment recommended for MERS-CoV infection. Current medical care for a hospitalized patient is syndrome-based: Supportive care for milder infection, or for severe cases, treatment includes care to support vital organ functions with oxygen, ventilator, or Extracorporeal Membrane Oxygenation.
For more information on Dr. Chun and his background expertise in infection prevention and control, visit his biography.
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