Robert Glatter, MD, Emergency Medicine, 11:15AM Jun 3, 2013
The World Health Organization (WHO) has identified 3 additional laboratory- confirmed cases of MERS-CoV in Italy over the past 24 hours, according to a recent update by the WHO.
A 45 year old man who recently spent time in Jordan, and traveled back to Italy in late May developed fever and cough and progressive respiratory distress, according to the WHO. He was hospitalized on May 28th in Italy and is stable at this time, according to recent reports. Unfortunately, two close contacts--his 2 year old granddaughter and a 42 year old female co-worker--have also been infected. Both are in stable condition at this time based on early reports.
MERS-CoV belongs to the coronavirus family and is responsible for illnesses ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). SARS, spreading from South China to Hong Kong, was responsible for over 775 deaths out of 8,273 cases worldwide between November, 2002 and July, 2003, according to the WHO. Within a few weeks, SARS spread from Hong Kong to infect individuals in 37 countries in early 2003.
While MERS-CoV is similar to SARS, it is not as easily as transmissible based upon clusters of patients evaluated to date. Thus far, out of 53 laboratory-confirmed cases of MERS-CoV since September of 2012, 30 have died.
Patients with Mers-CoV may develop either a mild upper respiratory illness or a more severe course, marked by respiratory failure, with pneumonia progressing to acute respiratory distress syndrome (ARDS) and kidney failure. Those with underlying diabetes, renal failure or coronary artery disease may be more at risk for severe illness, although there have already been a number of previously healthy patients affected as well.
Investigators have also noted that based on recently identified clusters, men seemed to predominate, with an unclear reason for the gender preference. It appeared as though a large proportion of females were apparently exposed to infected males but did not seem to routinely develop symptoms. Based upon more recently identified cases, women who had close contact with infected males have tested positive for MERS-CoV, dispelling the idea that women were somehow less likely to be vectors or have the ability to develop infection.
Thus far, supportive care-intravenous fluids , oxygen and antibiotics [if suspected secondary infection]- are among the potential treatments once infected, as there is no vaccine or specific antiviral with known activity against MERS-CoV.
Although respiratory secretions or a droplet mechanism of spread are theorized, standard practice of so-called universal precautions for healthcare workers (gown gloves, and mask), as well as isolation or quarantine protocols for persons presenting to emergency departments or hospitals with fever and upper respiratory symptoms with recent travel to the Middle East are in place at this time.
According to Margaret Chan, Director-General of the WHO, we still do not have a defined mechanism for spread, which ultimately makes it difficult for scientists to prevent development of infections.
The virus is "a threat to the entire world," Chan said last week and emphasized that "is not a problem that any single affected country can keep to itself or manage all by itself.