 What is MERS-CoV?

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel
coronavirus (Middle East respiratory syndrome coronavirus, or MERS‐CoV) that was first
identified in Saudi Arabia in 2012.
 Where it came from?
MERS-CoV is a zoonotic virus, which means it is a virus that is transmitted between animals
and people. Studies have shown that humans are infected through direct or indirect contact with
infected dromedary camels. MERS-CoV has been identified in dromedaries in several countries
in the Middle East, Africa and South Asia.
 How could it be transmitted?
Nonhuman to human transmission: The route of transmission from animals to humans is not
fully understood, but dromedary camels are the major reservoir host for MERS-CoV and an
animal source of infection in humans.
Human-to-human transmission: The virus does not pass easily from person to person unless
there is close contact, such as providing unprotected care to an infected patient. There have been
clusters of cases in healthcare facilities, where human-to-human transmission appears to have
occurred, especially when infection prevention and control practices are inadequate or
inappropriate.
 How to prevent and treat MERS-CoV?
No vaccine or specific treatment is currently available. As a general precaution, anyone
visiting farms, markets, barns, or other places where dromedary camels and other animals are
present should practice general hygiene measures, including regular hand washing before and
after touching animals, and should avoid contact with sick animals. 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.
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 that are processed appropriately through cooking or pasteurization are safe for
consumption, but should also be handled with care to avoid cross contamination with uncooked
foods. Camel meat and camel milk are nutritious products that can continue to be consumed after
pasteurization, cooking, or other heat treatments.
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. These people should avoid contact with camels, drinking raw camel
milk or camel urine, or eating meat that has not been properly cooked.
  Symptoms
The clinical spectrum of MERS-CoV infection ranges from no symptoms (asymptomatic) or
mild respiratory symptoms to severe acute respiratory disease and death. A typical presentation
of MERS-CoV disease is fever, cough and shortness of breath. Pneumonia is a common finding,
but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.
Severe illness can cause respiratory failure that requires mechanical ventilation and support in an
intensive care unit. The virus appears to cause more severe disease in older people, people with
weakened immune systems, and those with chronic diseases such as renal disease, cancer,
chronic lung disease, and diabetes.

 WHO response
WHO is working with public health specialists, animal health specialists, clinicians and
scientists in affected and at risk countries and internationally to gather and share scientific
evidence to better understand the virus and the disease it causes, and to determine outbreak
response priorities, treatment strategies, and clinical management approaches. WHO is also
working with the Food and Agriculture Organization of the United Nations (FAO) and the World
Organization for Animal Health(OIE) and national governments to develop public health
prevention strategies to combat the virus.
Together with affected countries and international technical partners and networks, WHO is
coordinating the global health response to MERS, including: the provision of updated
information on the situation; conducting risk assessments and joint investigations with national
authorities; convening scientific meetings; and developing guidance and training for health
authorities and technical health agencies on interim surveillance recommendations, laboratory
testing of cases, infection prevention and control, and clinical management.
Countries, whether or not MERS infections have been reported in them, should maintain a
high level of vigilance, especially those with large numbers of travellers or migrant workers
returning from the Middle East. Surveillance should continue to be enhanced in these countries
according to WHO guidelines, along with infection prevention and control procedures in health-
care facilities. WHO continues to request that Member States report to WHO all confirmed and
probable cases of infection with MERS-CoV together with information about their exposure,
testing, and clinical course to inform the most effective international preparedness and response.
  Is there a travel ban to countries in the Arabian Peninsula or neighboring countries where
MERS cases have occurred?
WHO has not issued travel health warnings for any country related to MERSCoV
 What to do if one resides in any of affected countries or one has recently traveled to
countries in the Arabian Peninsula or neighboring countries and got sick?
If you develop a fever & symptoms of lower respiratory illness, such as cough or
shortness of breath after a known exposure within 14 days to a seriously sick patient with
compatible signs and symptoms, or within 14 days after traveling from countries in the Arabian
Peninsula or neighboring countries, you should see your healthcare provider and mention your
recent exposure or travel.
 Are there available treatments for MERS-CoV?
There are no specific treatments for illness caused by MERS-CoV.
Medical care is supportive and to help relieve symptoms.
 Is there a laboratory test for MERS-CoV?
Yes. Laboratory tests (polymerase chain reaction or PCR) for MERS-CoV are available
in affected countries and here in the Philippines thru the Research Institute for Tropical
Medicine.
 Where to go for consultation or check-up?
In all DOH hospitals.
 What are the actions taken by the DOH?
Active Surveillance.
Readiness of hospital to handle MERSCoV cases.
Strengthen monitoring of passengers in all seaports and airports.
HOW CAN I PROTECT MYSELF?
Build Body Resistance
 Have plenty of sleep
 Drink plenty of fluids
 Eat nutritious food
 Avoid touching your eyes, nose, and mouth with unwashed hands.
 Avoid close contact, such as kissing, sharing cups, or sharing eating utensils, with sick people.
 Clean and disinfect frequently touched surfaces, such as toys and doorknobs
1. Minimize chance of exposure
 Ensure facility policies and practices are in place to minimize exposures to respiratory
pathogens including MERS-CoV.
 Measures should be implemented before patient arrival, upon arrival, and throughout the
duration of the affected patient’s presence in the healthcare setting.
 Before Arrival When scheduling appointments, instruct patients and persons who
accompany them to call ahead or inform HCP upon arrival if they have symptoms of any
respiratory infection (e.g., cough, runny nose, fever1) and to take appropriate preventive
actions (e.g., wear a facemask upon entry to contain cough, follow triage procedure).
 Upon Arrival and During the Visit. Take steps to ensure all persons with symptoms of a
respiratory infection adhere to respiratory hygiene and cough etiquette, hand hygiene, and
triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g.,
signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators,
cafeterias) to provide patients and HCP with instructions (in appropriate languages) about
hand hygiene, respiratory hygiene, and cough etiquette.
 Provide space and encourage persons with symptoms of respiratory infections to sit as
far away from others as possible. If available, facilities may wish to place these patients
in a separate area while waiting for care.
 Ensure rapid triage and isolation of patients who might have MERS-CoV infection
 Identify patients at risk for having MERS-CoV infection before or immediately upon
arrival to the hospital.
 Implement triage procedures to detect patients at risk for having MERS-CoV infections
during or before patient triage or registration (e.g., at the time of patient check-in) and
ensure that all patients are asked about the presence of symptoms of a respiratory
infection and history of travel to areas experiencing transmission of MERS-CoV or
contact with possible MERS-CoV patients.
 Provide supplies to perform hand hygiene to all patients upon arrival to facility (e.g., at
entrances of facility, waiting rooms, at patient check-in) and throughout the entire
duration of the visit to the healthcare setting.

2. Ensure Adherence to Standard, Contact and Airborne Precautions

 Standard precautions assume that every person is potentially infected or colonized with a
pathogen that could be transmitted in the healthcare setting.
 Attention should be paid to training and proper donning (put on), doffing (take off), and
disposal of any personal protective equipment.
3. Hand Hygiene
 HCP should perform hand hygiene before and after all patient contact, contact with
potentially infectious material, and before putting on and upon removal of PPE, including
gloves.
 Hand hygiene in healthcare settings can be performed by washing with soap and water
for at least 20 seconds or using alcohol-based hand rubs.
  If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.
Facts/ Short Summary
1. Between 2012 and December 2016, 1,841 laboratory-confirmed cases of MERS-CoV have been
reported to the World Health Organization (WHO), 80 percent of which have been from Saudi Arabia.

2.The Centers for Disease Control (CDC) has issued a Level 2 Alert, signifying “Practice Enhanced
Precautions,” for people traveling to the Arabian Peninsula.

3.MERS-CoV is communicable in nature. However, it does not easily pass from human to human unless
there is close contact, such as in a healthcare setting. Though we still do not know of the virus’s exact
communication method, it is thought to be transmitted through an infected person’s respiratory
secretions such as coughing.

4.MERS-CoV is a zoonotic virus, which means that it is transmitted between animals and humans.
Studies have shown that the virus has been transmitted to humans through direct or indirect contact
with infected dromedary camels.

5.The WHO recommends that people traveling to the Arabian Peninsula avoid contact with camels and
are advised against drinking camel milk or raw camel urine and eating undercooked meat of any kind,
especially camel meat.

6.Once infected, a person shows symptoms like fever and cough with initial clinical features
symptomatic of Severe Acute Respiratory Syndrome (SARS).

7.Outside of the Arabian Peninsula, the largest known outbreak of MERS occurred in the Republic of
Korea in 2015. The patient zero for this outbreak was identified as a traveler returning from the Arabian
Peninsula.

8.MERS has been categorized as a very low-risk illness in the U.S. Only two positive cases have ever been
reported in the U.S., and both of these cases were among healthcare providers who had worked in the
Arabic peninsula.

9.The mortality rate for MERS-CoV patients is around 35 percent. However, those that died have been
known to have an underlying medical condition. Some of the reported pre-existing conditions included
cancer, diabetes and chronic lung, heart and kidney disease. In addition, people with weakened immune
systems are more likely to be infected or have a severe case of the disease.

10.Most patients without any underlying pre-existing conditions exhibited mild or no symptoms and
made a full recovery.