Middle East respiratory syndrome coronavirus (MERS-CoV) – Malaysia
On 2 January 2018, the National IHR Focal Point of Malaysia reported one case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
Details of the case
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The case, a 55 year old male who resides in Malaysia, traveled as a member of a pilgrimage group to KSA from 13-23 December 2017. The case reported a history of exposure to dromedary camels (drinking unpasteurized camel milk and direct contact with a camel) while visiting a camel farm in Riyadh on 20 December 2017. The case developed symptoms on 24 December, was treated and hospitalized in Malaysia. Currently the case is asymptomatic and in hospital.
The Ministry of Health is closely monitoring 70 individuals who have had close contact with the case, which include family members, Umrah pilgrims from the same pilgrimage as the case, healthcare professionals in the healthcare facilities and other close airline contacts.
As of 5 January, no further cases have been identified in Malaysia. Of the 70 contacts identified and followed by the Malaysian Ministry of Health, 61 contacts have had no symptoms. Nine contacts had mild symptoms and were admitted to an isolation ward. Samples from the 9 symptomatic contacts were negative for MERS-CoV, and, subsequently, they were discharged from hospital. Forty-one asymptomatic close contacts were placed under home surveillance for 14 days from the last day of contact with the 55 year old laboratory confirmed MERS-CoV case. Out of these 41 asymptomatic close contacts, 22 tested negative for MERS-CoV while tests are still pending for the remaining 19 contacts.
This is the second case of laboratory-confirmed MERS-CoV reported from Malaysia. The previous imported case was reported in Malaysia in 2014.
Globally, since September 2012, WHO has been notified of 2,123 laboratory-confirmed cases of infection with MERS-CoV in 27 countries, including at least 740 deaths.
Public health response
The Ministry of Health has taken the following prevention and control measures:
- Identification of all contacts of the laboratory confirmed case (as described above). Symptomatic contacts were placed in isolation in hospital and tested for MERS-CoV by RT-PCR. Asymptomatic contacts were placed under home isolation and monitored for 14 days following last contact with the laboratory confirmed case.
- Further strengthening of surveillance of ‘Influenza-like Illness’ (ILI) and ‘Severe Acute Respiratory Infection’ (SARI) throughout Malaysia, particularly among returning pilgrims from KSA.
- Intensifying alertness and case management of patients under investigation for MERS-CoV in all health facilities.
- Enhancement of infection prevention and control measures at all health care facilities.
- Reinforcement to the Ministry of Tourism, Department of Islamic Development Malaysia and Malaysian Hajj Pilgrims Fund Board on advice to tour agencies offering Hajj packages to take necessary precautions to prevent pilgrims from being exposed to MERS-CoV while travelling to the Middle East.
The Ministry of Health in KSA is investigating the source of infection of the confirmed case while he was KSA.
WHO risk assessment
Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in healthcare settings.
The notification of additional cases does not change WHO’s overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to animals or animal products (for example, following contact with dromedaries) or human source (for example, in a healthcare setting). WHO continues to monitor the epidemiological situation and conducts the risk assessment based on the latest available information.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV between people in healthcare facilities. It is not always possible to identify patients with MERS-CoV infection early because, like other respiratory infections, the early symptoms of MERS are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.
Community and household awareness of MERS and MERS prevention measures in the home may reduce household transmission and prevent community clusters.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS-CoV infection. Therefore, in addition to avoiding close contact with suspected or confirmed human cases of the disease, people with these conditions should avoid close contact with animals, particularly camels, when visiting farms, markets, or barns in areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.
Countries should advise travellers on how to prevent infection with MERS-CoV while travelling to affected areas.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.