..

4. 4

5. Professor Ali Mohamed Zaki, who diagnosed the first
patient with a strain of the novel coronavirus in
Saudi Arabia, stands in his office in Cairo.
5

6. 6

7. MERS Cases and Deaths,
April 2012 – November 1, 2013
Countries Cases (Deaths)
 France 2 (1)
 Italy 1 (0)
 Jordan 2 (2)
 Qatar 7 (3)
 Saudi Arabia 124 (52)
 Tunisia 3 (1)
 United Kingdom (UK) 3 (2)
 United Arab Emirates (UAE) 6 (2)
 Oman 1 (0)
 Total 149 7 (63)

8. 24 April 2014
 Since April 2012, reporting countries in the Middle East
include Jordan, Kuwait, Oman, Qatar, Kingdom of
Saudi Arabia (KSA) and the United Arab Emirates (UAE)
 in Europe: France,Germany, Greece, Italy and the
United Kingdom (UK)
 in North Africa: Tunisia
 in Asia: Malaysia and the Philippines.
8

9. 9

10. 7 May 2014
 Globally, from September 2012 to date, WHO has
been informed of a total of 496 laboratory-confirmed
cases of infection with MERS-CoV.
 This total includes 229 cases reported between 11
April and 4 May by Saudi Arabia, and the recent
reports of 3 cases from Jordan, and one case each
from Egypt, the United States, and Yemen.
 About 30% of these people died
10

11.  The occurrence of new cases seems to follow a
seasonal pattern, with increasing incidence from
March‐April onwards.
 The number of cases sharply increased since
mid‐March 2014, essentially in KSA and UAE,
where two important health care‐associated
outbreaks are occurring.
11

12. WHO RISK ASSESSMENT
24 April 2014
 As much as 75% of the recently reported cases
appear to be secondary cases, meaning that they
are considered to have acquired the infection from
another infected person.
 The majority of these secondary cases are mainly
healthcare workers who have been infected within
the healthcare setting, although several patients who
were in the hospital for other reasons are also
considered to have been infected with MERS‐CoV
in the hospital .
12

13.  The majority of the infected healthcare workers
presented with no or minor symptoms.
 No large family cluster has been identified.
 Screening of contacts revealed very few instances of
household transmission; and no increase in the size or
number of household or community clusters has been
observed.
 When human‐to‐human transmission occurred,
transmission was not sustained
13
WHO RISK ASSESSMENT
24 April 2014

14.  The number of cases who acquired the infection in
the community has also increased since mid‐ March.
 These cases have no reported contacts with other
laboratory confirmed cases, and some have reported
contacts with animals.
 Although camels are suspected to be the primary
source of infection for humans, the exact routes of
direct or indirect exposure remain unknown.
14
WHO RISK ASSESSMENT
24 April 2014

15.  In view of the increasing number of cases – in
particular secondary cases, nosocomial
outbreaks and exported cases
 The majority of the cases now reported have
likely acquired infection throug human‐to‐human
transmission and only about a quarter are
considered as primary cases, which suggests
slightly more human‐to‐human transmission than
previously observed.
15
WHO RISK ASSESSMENT
24 April 2014

16. Has the transmission pattern of
MERS‐CoV changed?
 One hypothesis is that the transmission pattern and
transmissibility have not changed and that the
occurrence of two large nosocomial outbreaks
reflects inadequate infection prevention and control
measures, coupled with intensive contact tracing and
screening.
 An alternative hypothesis is that transmissibility of the
virus has increased and is resulting in more
human‐to‐human transmission as the basis for the
recent upswing in cases.
16

17. 17

18. 18

19.  All of the laboratory confirmed cases had respiratory
disease as part of the illness, and most had severe
acute respiratory disease requiring hospitalization
 Most people who got infected with MERS-CoV
developed severe acute respiratory illness with
symptoms of fever, cough, shortness of breath and
breathing difficulties. .
 Pneumonia has been the most common clinical
presentation
19
Clinical Features

20.  In people with immune deficiencies, the disease
may have an atypical presentation.
 Many have also had gastrointestinal symptoms,
including diarrhoea.
 Most patients were reported to have at least one
comorbidity.
20
Clinical features

21. Clinical features
Complications in fatal cases
1. Acute respiratory distress syndrome (ARDS)
2. Acute Renal failure requiring hemodialysis
3. Disseminated intravascular coagulation ( DIC )
4. Pericarditis.
5. Multiple organ failure
● Fatality rate ~ 30%

22. Diagnosis
 The main test for this particular coronavirus is a
screening PCR tests (polymerase chain reaction)
test followed by a more specific confirmatory test
 Nasopharyngeal swabs may be less sensitive
than specimens of the lower respiratory tract
according to WHO, June 2013.
22

23. Laboratory testing
 Collect specimens for MERS-CoV testing
from all PUIs (patient under investigation)
– An upper respiratory specimen:
 Nasopharyngeal AND oropharyngeal swab
– A lower respiratory specimen:
 Sputum, OR
 Broncheoalveolar lavage, OR
 Tracheal aspirate, OR
 Pleural fluid
23

24.  Patient samples from the lower respiratory tract,
not just the nasopharynx/throat.
 if lower respiratory tract specimens are not
possible both nasopharyngeal and
oropharyngeal swab specimens should be
collected, as well as stool and serum.
24
Laboratory testing

25. WHO criteria for “patient under
investigation (PUI)” for MERS-CoV
infection

26. Who should be investigated?
 SARI + PPD + either
– Traveled to middle east - 14 days
– In a cluster (within 14 days )
– HCW exposed to pt with severe LRTI
– unexpected clinical course unexplained by
current aetiology
 ARI of any severity
– Close contact with confirmed/probable MERS-CoV
( within 14 days)
 Middle East, any ventilated pt
SARI = severe acute respiratory illness
PPD = pulmonary parenchymal disease 26

27. SARI + PPD + either
 Cluster (>1 persons in a specific setting -classroom, workplace,
household, extended family, hospital, other residential institution, military
barracks or recreational camp) that occurs within 14-days,
WRTHOT unless another aetiology identified (UAAI).
 HCW working with severe ARI patients (particularly ICU)
WRTHOT UAAI
 travel to the Middle East within 14 days before onset of
illness, UAAI.
 Unusual or unexpected clinical course, especially
sudden deterioration despite appropriate treatment,
WRTHOT , even if another aetiology has been
identified, if it does not fully explain the presentation
or clinical course of the patient.
WRTHOT = without 27 regard to history of travel

28. تعريف مؤقت لحالة العدوى المستجده بفيروس
)3/7/ كورونا ) 2013
)مريض قيد الفحص(:
شخص مصاب بعدوى مرض تنفسى حاد ) سعال وضيق فى التنفس 
والتهاب رئوى شعبى يتم تشخيصه بالكشف الاكلينيكى او بالاشعه ( قد
تكون مصحوبه بارتفاع بدرجة الحراره اكثر من او يساوى 38 درجه مئويه.
مع: 
-1 تاريخ للسفر او الاقامه خلال 14 يوم قبل ظهور الاعراض فى منطقه ابلغ
فيها بالأونه الاخيره عن الاصابه بعدوى مستجده بفيروس كورونا ) دول
شبه الجزيره العربيه( او اى منطقه قد يظهر فيها عدوى المرض. أو
-2 ظهور الاعراض والعلامات السابقه لحالات مجمعه ) حالتان أو اكثر ظهرت
عليهم الاعراض خلال نفس فترة 14 يوم ومرتبطين بالمكان ) مدرسه ،
منزل، مكان عمل، .... الخ(. أو
28

29. )تابع مريض قيد الفحص(:
-3 حاله تتعامل فى مجال تقديم الخدمه الصحيه لمرضى مصابين
بعدوى تنفسيه حاده خاصه مراكز العنايه المركزه. أو
-4 حاله لديها التهاب رئوى غير معروف السبب خاصة الحالات سريعة
التدهور برغم العلاج المناسب. أو
-5 جميع حالات العدوى التنفسيه الشديده الموجوده على جهاز
التنفس الصناعى.
الحالات المحتمله : 
شخص ينطبق عليه تعريف الحاله ) مريض قيد الفحص( المذكور
عالية مع مخالطة مباشره خلال 14 يوم قبل ظهور الاعراض
لشخص مصاب بحاله مؤكده معمليا.
29

30. 30

31. 31

33. How can people protect themselves
from getting MERS-CoV?

34. 34

36. 36

37. 37

38. Infection control
Standard precautions
+
Droplet precautions
+
Contact precautions
Airborne for aerosol generating proceedures
38

39. 39

40. 40

41. 41

42. 42

43. 43

44. 44

46. 46

47. 47

48. 48

49. Final Messages!
“The only thing more difficult than
planning for an emergency is having
to explain why you didn’t.”
Be Proactive NOT Reactive!!!!

50. 50