Post 117 – MERS Reaches the United States

About a year ago, I wrote about a new virus that was spreading across the Middle East.  In the past two weeks, news came of incidences of MERS-CoV in the States, now shortened to “MERS.”  Both were health care workers based in the United States and traveled to the Mid-East to provide services. First person traveled from Riyadh in Saudi Arabia to London to Chicago, then took a bus to Indiana, where he developed symptoms and went to a hospital emergency room.  I understand he has since been discharged.

In the second case, which is not considered linked to the first, the health care worker traveled from Jeddah in Saudi Arabia to London to Boston to Atlanta and to Orlando.  He started having fever, chills, and slight cough during his first flight and it just got worse.  Two health care workers tending to him also developed respiratory symptoms and were hospitalized.

While writing this today, I found that they suspect a third case from someone who was in contact with the first case.

 

Spread through flights around the world

MERS Warning

Poster showing MERS Health Advisory from CDC

Signs warning of the MERS virus for people traveling to the Mideast has been posted in 22 United States airports in the past month, including LAX, Las Vegas and Boston. The posters state steps to reduce risk of transmission.

 

So what would they do in the hospital?  

Disclaimer: What I am writing are expected, typical procedures, based on my experiences.  I do not know of specific events for either patients’ cases.

MERS, based on reports, presents itself as a respiratory illness with fever, cough, and shortness of breath.  Clinicians will care for it as a respiratory illness, offering care to reduce fever and cough and improve breathing.

They will, in the “History of Present Illness” (HPI) part of asking the patient of the illness, ask whether the patient has traveled outside the country.  If the patient states something about the Middle East, I’m sure alarm bells, flags, flashing lights will go off in the caretaker’s head.  They will isolate the patient.  They will contact the local public health office’s “Health Provider Hotline” to report this case. CDC presents interim guidelines for healthcare providers.

 

New Information, 1 year later

I wrote that it was centered in the Saudi Arabia peninsula and there were 30 deaths and over 50 cases at the time.  Oftentimes the first instance of a newfound “bug” can cause extreme symptoms and outcomes, until researchers find effective treatments against it. It takes time. This happened with the HIV virus when it was first found.  It created great alarm and fear. Now, it’s no longer considered a death sentence.

As of Friday, May 9, World Health Organization (WHO) has confirmed 538 cases in 17 countries (including the Indiana case) and 145 have died.  All these cases have been linked to six countries on or near the Arabian Peninsula.

The virus can spread from person-to-person, but only in close contact, like in a health care setting. There is no evidence of spread easily from person-to-person in the community.

Research published this month also showed a similar virus is found in camels. Genetic analysis found numerous substrains of MERS in the viruses camels carry, “including one that perfectly matches a substrain isolated from a human patient” (CNN, 5/5/2014).

That means there’s a genetic match between a virus found in a camel and a virus from a MERS human patient.  It could mean that the MERS virus transmitted from camel to a human. This study is published in mBio Journal – http://mbio.asm.org/content/5/3/e01146-14

Those of you who’ve taken microbiology and want a review of coronaviruses (or those who are about to take the class can preview this class of viruses) – these viruses cause the common cold, too – may want to check out the CDC Coronavirus page – http://www.cdc.gov/coronavirus/

Here are specific sites to monitor for this illness:

References:

 

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