Global Public Health Update: MERS becoming a SARS redux?
May 6, 2014 Update – More Frightening Developments… and Some Hope
On Friday, May 2, the Centers for Disease Control & Prevention (CDC) published the first confirmed report of a MERS-CoV infection in the United States. The patient was discovered in Indiana on April 24 after returning from a trip to Saudi Arabia. While the story of the infected person has not yet been completely unveiled, we do know that they are a health care worker that practiced in Saudi Arabia during their ongoing outbreak. As in the 2003 SARS outbreak, healthcare workers seem to be amongst the at risk categories likely due to their exceptionally long periods of potential exposure during treatment of infected persons. While the Indiana patient is in stable condition and isolated, their episode truly brings home the risks associated with an emerging infectious disease like MERS-CoV. It also underscores the necessity of our healthcare workers to observe and adhere to infection control best practices to reduce risk of nosocomial infection.
Fortunately, not all of the recent MERS-CoV news has been bad. Researchers at the University of Maryland in concert with partners at the pharmaceutical company, Novartis, published a peer-reviewed article last week (April 30) that highlights the use of a novel vaccine development strategy to produce a viable MERS-CoV candidate vaccine in mice. While these results are extremely preliminary and should be considered with appropriate caution, they do reflect the exceptional efforts and capabilities of the scientific community to address the challenges posed by a novel emerging infectious disease like MERS-CoV. This candidate vaccine has a number of hurdles that must be cleared to show safety and efficacy in humans, but none-the-less this research represents a potential reason for optimism in a period of otherwise frightening MERS developments.
Original post from April 24, 2014:
An illness of unknown source and cause begins to spread across Asia. The victims experience flu-like symptoms that progress to a potentially lethal pneumonia. The disease is particularly insidious given its penchant for attacking medical providers or those accessing the healthcare network for treatment for other maladies. The world scrambles to respond while holding more questions than answers. This story occurred in 2002 with the outbreak of Severe Acute Respiratory Syndrome (SARS). It appears to be repeating itself today with the Middle East Respiratory Syndrome (MERS).
Over the last week, more than 50 new cases of the virus have been reported in Saudi Arabia, including 13 on Monday, April 21, 2014 alone. These new cases bring the total of confirmed infections to 257 (CNN) since MERS was discovered in 2012. More than 30% of the total cases have occurred in the last month.
The spread of the virus has governments and communities scrambling. The Saudi Arabian Health Minister was removed by royal decree. Facemasks are gone from the shelves in many areas throughout Saudi Arabia. Reports indicate that medical providers have begun to decline treatment of suspected MERS cases. If true, this represents yet another disturbing development in the progression of this emerging disease. It comes immediately on the heels of reports that paramedics in the United Arab Emirates were infected (CIDRAP). That healthcare workers or those accessing the healthcare network are at greater risk of infection could serve as a complicating factor in this outbreak…. And a stark reminder of a previous relative of the MERS.
Modern medicine relies on information gleaned from generations of knowledge about the diseases humans have battled for decades or more. Unfortunately MERS, like SARS before it, represent scary new members of the emerging infectious disease family. Researchers have little knowledge upon which to base sound medicinal and public health decisions. This makes the virus both difficult to treat and difficult to control.
Like MERS, SARS was marked by healthcare-associated infections (CBC). The spread of SARS was stopped in large part by the quick thinking, and sometimes sacrificial, efforts of medical providers in various countries throughout the world. These valiant doctors, nurses and other health care workers implemented many of the tried and true public health methods: isolation, quarantine and the use of physical barriers, such as masks and social distancing, to slow the spread of a poorly understood virus. This effort is repeating itself globally today with MERS. Will it be effective? Time will tell, but the importance of this effort cannot be underestimated.