Saturday, 19 April 2014

MERS-CoV detection: Cases by week and cumulative average still rising thanks to 2 healthcare clusters

Click on image to enlarge.
This chart, cases by week, really tells the story of a super-cluster driven by Jeddah's hospitals. Why this is still rolling along is unclear.

Perhaps, just perhaps (and I'm hand waving here), we can say that because MERS-CoV cases are not popping up all over Saudi Arabia, and because it seems, so far, that the contacts of the imported Malaysian (ex Jeddah) and Filipino (ex UAE) cases are testing negative for MERS-CoV, that a significant change to create MERS-CoV MkII may not have occurred. If it had, seeing positive test results among contacts and family members would be a good indirect alarm bell. But we have not seen much of that in cases to date, and in past umrah and Hajj pilgrimages. 

The clock on the maximum incubation period has probably run out for the Malaysian fatal case who became ill 4-April. The Filipino case may also have run down his clock. He tested negative for MERS-CoV 11-days after his exposure in the UAE. As far as we know there are no positive contacts or family members from these 2 exported cases.


But then there was SARS....

If we could for a minute use that absence of new cases in those new international sites (also watching Greece now) to cross off viral change (still need to see viral sequences to be able to do that conclusively; Spike please!), that could leave us to focus on a breakdown in infection control and in the prevention of infection in hospital settings. 

I understand that healthcare workers don't walk around in full gloves, goggles, gowns and N95 masks for their entire shift (fyi, as lab researchers, we have to wear gloves, safety goggles and back fastening lab coats while we work in a PC2 laboratory environment with these viruses which we handle in a Class II Biosafety Cabinet), but I do wonder why we have guidelines for managing patients with certain signs and symptoms, if, and emphasise if, they are not to be followed. 

Such a guideline can be found in the very comprehensive publication listed below [1]...Table 1 about handling SARS patients seems particularly relevant. I wrote about this publication back in August 2013 [3], with the help of Mike Coston who has an extensive range of expert information on preventing infection over at his Avian Flu Diary blog.[2]

The recent spate of MERS-CoV cases is a grim but timely reminder of why HCWs need to be extra cautious when dealing with respiratory infection cases; you never know what might come through the door.

References..
  1. Infection prevention and control measures for acute respiratory infections in healthcare settings: an update | Seto et al | Eastern Mediterranean Health Journal
    http://applications.emro.who.int/emhj/v19/Supp1/EMHJ_2013_19_Supp1_S39_S47.pdf
  2. Avian FLu DIary | search for N95
    http://afludiary.blogspot.com.au/
  3. Infection Prevention and Control measures for MERS..mostly as per other ARIs
    http://virologydownunder.blogspot.com.au/2013/08/infection-prevention-and-control.html