【病毒外文文献】2015 Middle East respiratory syndrome coronavirus (MERS-CoV) in pilgrims returning from the Hajj.pdf

MERS-COV AND THE HAJJMiddle East respiratory syndrome coronavirus(MERS-CoV) in pilgrims returning from the HajjAlexander Kumar NIHR academic clinical fellow infectious diseases1, Gail Beckett senior healthprotection nurse2, Martin Wiselka infectious diseases consultant11Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK;2Public Health England, East MidlandsCentre, Nottingham City Hospital, Nottingham, UKLast month around two million international pilgrims travelledto Mecca in Saudi Arabia to join in the annual Islamic Hajjpilgrimage before returning home to their countries of origin.Crowded close human and animal contact has caused previouscommunicable disease outbreaks.1Coronaviruses2such asMiddle East respiratory syndrome coronavirus (MERS-CoV),which causes Middle East respiratory syndrome (MERS), haveresulted in nosocomial outbreaks characterised by earlynosocomial super-spreading events and transmission patternsinvolving healthcare workers. This poses great clinical concernas a potential cause of epidemics and threat to global health.In Saudi Arabia, 1231 MERS-CoV infections have resulted in521 deaths and onward transmission to 21 countries.3-6Theinitial infection causes an upper respiratory tract illness with anincubationperiodof14daysandanaveragecasefatalityaround35%. Delayed diagnosis in a South Korean traveller infectedwith MERS-CoV in Saudi Arabia recently caused the largestoutbreak of MERS outside Saudi Arabia, with onwardtransmission of 186 infections, resulting in 36 deaths and anestimated socioeconomic impact of up to $10bn (£6.6bn;€8.94bn).7-9Awareness of MERS in healthcare workers remains low. Yetthe risk of returning Hajj pilgrims contracting and spreadingMERS-CoV from Saudi Arabia is high.10To help to identifycases and stop similar preventable tragic outbreaks, PublicHealth England has issued a warning to be aware of MERS inHajjtravellers,aswellasfullguidanceonthesamplesrequired,diagnostics, management, and reporting of suspected andconfirmed cases.11 12MERS-CoV should be considered in any patient presenting tofrontline medical services with a flu-like illness or pneumoniawho has travelled within 14 days before symptom onset to anyhigh risk countries, including in the Arabian peninsula; a riskassessmentisrequiredusingthePHEcasedefinitionforpossibleMERS-CoV (box). There is no specific treatment of or vaccineagainst MERS-CoV but patients can recover with earlysupportive care.13Competing interests: None declared.Full response at: Health Organization. Health conditions for travellers to Saudi Arabia for thepilgrimage to Mecca (Hajj). Weekly Epidemiological Record (WER) 2010;85:425-36. www.who.int/wer/2010/wer8543/en.2Pebody R, Zambon M, Watson JM. Novel coronavirus: how much of a threat? BMJ2013;346:f1301.3Smith RD. Responding to global infectious disease outbreaks: lessons from SARS on therole of risk perception, communication and management. Soc Sci Med 2006;63:3113-23.4Zaki AM, van Boheemen S, Bestebroer TM, et al. Isolation of a novel coronavirus from aman with pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814-20.5Chastel C. Middle East respiratory syndrome (MERS): bats or dromedary, which of themis responsible? Bull Soc Pathol Exot 2014;107:69-73.6Chowell G, Abdirizak F, Lee S, et al. Transmission characteristics of MERS and SARSin the healthcare setting: a comparative study. BMC Med 2015;13:210.7Lim PL. Middle East respiratory syndrome (MERS) in Asia: lessons gleaned from theSouth Korean outbreak. Trans R Soc Trop Med Hyg 2015;109:541-2.8World Health Organization. Middle East respiratory syndrome coronavirus(MERS-CoV)—Kuwait. www.who.int/csr/don/23-september-2015-mers-kuwait/en/.9Zumla A, Hui DS, Perlman S. Middle East respiratory syndrome. Lancet2015;386:995-1007.10Ministry of Health, Spain. Detectado un caso importado del nuevo coronavirus en España.www.msssi.gob.es/gabinete/notasPrensa.do?id=3081.11UK Government. MERS-CoV: public health investigation and management of possiblecases. https://www.gov.uk/government/publications/mers-cov-public-health-investigation-and-management-of-possible-cases.12UK Government. Hajj pilgrims urged to be aware of MERS advice. https://www.gov.uk/government/news/hajj-pilgrims-urged-to-be-aware-of-mers-advice.13World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV).www.who.int/emergencies/mers-cov/en/.Cite this as: BMJ 2015;351:h5185© BMJ Publishing Group Ltd 2015ak583@leicester.ac.ukFor personal use only: See rights and reprints 2015;351:h5185 doi: 10.1136/bmj.h5185 (Published 30 September 2015)Page 1 of 1LettersLETTERSPHE case definition—possible case of Middle East respiratory syndrome coronavirus (MERS-CoV)*Any person with severe acute respiratory infection needing admission to hospital with symptoms of fever (≥38ºC), or history of fever,and coughANDWith evidence of pulmonary parenchymal disease (such as clinical or radiological evidence of pneumonia or acute respiratory distresssyndrome (ARDS))ANDNot explained by any other infection or causeAND at least one ofHistory of travel to, or residence in an area where infection with MERS-CoV could have been acquired in the 14 days before symptomonset†ORClose contact during the 14 days before onset of illness with a confirmed case of MERS-CoV infection while the patient was symptomaticORHealthcare worker based in intensive care unit (ICU) caring for patients with severe acute respiratory infection, regardless of history oftravel or use of personal protective equipmentORPart of a cluster of two or more epidemiologically linked cases within a two week period requiring ICU admission, regardless of historyof travel*www.gov.uk/government/uploads/system/uploads/attachment_data/file/461192/MERS-COV_RA_sep_2015_final.pdf†This definition includes all countries within the geographical Arabian Peninsula, plus countries with cases that cannot beconclusively linked to travel; as of 16 September 2015: Bahrain, Jordan, Iraq, Iran, Kingdom of Saudi Arabia, Kuwait,Oman, Qatar, United Arab Emirates, Yemen, and South Korea.For personal use only: See rights and reprints 2015;351:h5185 doi: 10.1136/bmj.h5185 (Published 30 September 2015)Page 2 of 1LETTERS。