Middle East Respiratory Syndrome

Coronavirus (MERS-CoV)

Presented by:
Indera bin Mansor (P77052)
Normawati binti Yusoff (P77039)
Hawa Bee binti Ibrahim (P77046)
Noor Hasmadi bin Mohamad Noor
(P77042)

CONTENT

Introduction (Presenter 1)
MERS-CoV Cases (Presenter 1)
First & Only Case in Malaysia (Presenter 1)
Source of Transmission (Presenter 2)
Mode of Transmssion (Presenter 2)
Speculated Transmission (Presenter 2)
Pathogenesis (Presenter 2)
Incubation Period (Presenter 2)
Symptoms (Presenter 3)
People at Risk (Presenter 3)
Treatment (Presenter 3)
Prevention (Presenter 4)

What is
MERS-CoV

INTRODUCTION
Item
Virus type

History of
disease
Originated

MERS-CoV
Lineage C/

SARS-CoV
Lineage B/

Betacoronaviridae

Betacoronaviridae

September 2012

November 2002

Saudi Arabia

China

Until now
Suspected from animal

Until July 2003

Suspected from bat to fox
before
transmitted
to
human
8273 cases

No. of cases 909 cases

Case
Fatality
Rate

331 death
36%

725 death
8.76%

Continued
First identified: Saudi Arabia September 2012
two patients who suffered severe
pneumonia (Zaki et al. 2012).
Different from the SARS coronavirus
(Muller et al. 2012).

MERS-CoV CASES
Until 7th Nov. 2014, 23 countries reported
MERS-CoV confirmed case to WHO.
Middle
East

Africa

Saudi Arabia
United
Arab
Emirates (UAE)
Iran
Jordan
Kuwait
Lebanon
Oman
Qatar
Yemen

Algeria
Egypt
Tunisia

(Source : MOH 2014)

Europe

Austria
Holland
Greece
Italy
Germany
France
Turkey
United Kingdom (UK)

Asian

Philippines
Malaysia

America

United States of America

(USA)

DISTRIBUTION OF CONFIRMED
CASES (2012 -2014)

(Source : ECDC 2014)

MERS-CoV CASES

As of 7th November 2014

909
laboratory-confirmed
cases
of
infection with MERS-CoV including
331 related deaths have been reported
to WHO.
(Source : MOH 2014)

FIRST & ONLY CASE IN MALAYSIA

Source : MOH 2014)

54 year old Male Diabetic

29th March 2014 - returning
from Umrah
4th April 2014 - not Feeling
well
7th April 2014 - went to clinic
9th April 2014 refer to the
hospital
Symptoms : fever, cough,
shortness of breath
13th April 2014 Died

SOURCE OF TRANSMISSION
Uncertain.
Animal origin?
Speculated animals :
Bats
A number of viruses detected in bats in
Europe and China (Li et al. 2005); Saudi
Arabia (Memish et al. 2013)
MERS-CoV in a bat faeces samples
Camels
Several studies have identified MERS-CoV in
high proportion of camels - Likely reservoir
(Perera et al. 2013 ; Reusken et al. 2013)

MODE OF TRANSMISSION
Unclear.
But most likely thru direct contact
(contamination of the environment)
or inhalation (coughing, sneezing).
Reservoir' or zoonotic transmission
has yet to be identified for MERS-CoV
(Memish et al. 2013).

Continued
Pandemic potential risk for MERS-CoV does
not exceed 5% (Brban et al. 2013). This
indicates a low risk potential for
transmission from person to person
(Cauchernez et al. 2013).
Cases have occurred in a health care
facility
or
among
close
family
members
(Buchholz et al. 2012; Puzelli et al. 2013)

SPECULATED TRANSMISSION
Coronavirus

Agent

Bat

Reservoir

Camel

Host

Person
handling
camel

Transmission

OR
Coronavirus

Agent

Camel

Reservoir

Person
handling
camel

Host

Person
sneezing

Transmission

PATHOGENESIS
People direct contact with
camel or thru inhalation

Coronavirus enter
the respiratory tract
Coronavirus multiplies &
spreads
Symptoms : Hi Fever,
cough etc.
Coronavirus causes injury
to the lung : Pneumonia

INCUBATION PERIOD

1.9 - 14.7 days (Assiri et al.

2013)

MOH Saudi Arabia 2014)

Pneumonia

Abdominal pain

Cough

ever above 38c

Diarrhea

SYMPTOMS
Symptom
Symptom
Vomitting

Sore throat

Headache Shortness of breath

PEOPLE AT RISK
i.People with low immune system
ii.
Elderly
iii.
Children under 12 years old
iv.
Pregnant women
v.
People with chronic diseases
vi.
Close contact :
Any person who provided care for the patient.
(healthcare worker or family member, or had similarly close physical
contact).
Any person who stayed at the same place.
(e.g. lived with, visited) as the patient while the patient was ill.
(Source : Jadav 2013)

TREATMENT
No specific treatment No vaccine available

Treatment based on the

patients symptoms.

Currently awaiting
clinical trial.

Supportive care is
highly effective

(Source : Jadav 2013)

DIAGNOSIS
Exposure Information and travel history
Animal exposures
Human exposures
Food exposures
Travel history
Clinical Information
Signs and symptoms at initial presentation.
Dates and results of any ancillary tests
performed
(X-Ray, CT scan)
(Source : WHO 2013)

Continued
Confirmation lab tests
throat swabs samples (throat swab)
test using the 'Real-time Reverse
Transcriptase
Polymerase
Chain
Reaction (RT-PCR)
(Source : Corman et al. 2012)

PRIMORDIAL PREVENTION

To prevent the
emergence of risk
factors

PRIMORDIAL PREVENTION
AVOID of visits to farm animals (especially
camel farm).
Personal hygiene.
AVOID raw food & the use of drinking
untreated water supply.
DO NOT touch the fruit of vegetables that are
not washed.
AVOID direct contact of pilgrims & visitors
from middle east who have symptoms of
respiratory infection (such as fever, cough,

PRIMARY PREVENTION

To Prevent
Infection via :
1. Specific
Protection
2. Health
Promotion

SPECIFIC PROTECTION IN
MALAYSIA
Theres
no
specific
vaccination for MERS-CoV.
Vaccination
:
against
influenza & pneumococcal.
Mask to cover mouth
nose and hand sanitizer.

&

HEALTH PROMOTION IN MALAYSIA

Standee at Airport

Streamer

HEALTH PROMOTION
IN MALAYSIA

Pamphlets

HEALTH PROMOTION
IN MALAYSIA
Health education to the Umrah & Hajj pilgrims
through Hajj Intensive Courses & Course Hajj
pilgrimage undertaken by the Lembaga Tabung Haji
(LTH).
Health advisory issued by
uploaded by the LTH website.

the

MOH

will

be

MASS MEDIA CAMPAIGN

Info Kesihatan

http://www.moh.gov.m
y

SECONDARY PREVENTION

To Prevent Disease
by :
1. Early Diagnosis
2. Treatment

HEALTH SCREENING

Travellers from
Middle east countries

SCREENING AT THE ENTRY POINT

Arrival at the international
entry points
FEVER/ TEMPERATURE
SCREENING

FEVER

Allow to go
home with
Health Alert
Card
Allow to go home with
BOTH, the :
Health Alert Card
Home Assessment Tool

FURTHER
ASSESSMENT
History taking
Clinical
examination

SEVERI
TY?

Immediate referral to the identified hospital; for

admission and further management
To initiate infection prevention and control measures
including disinfection of the aircraft/ conveyance
To initiate contact tracing and obtain flight manifest of
the affected flight
To share information of referred case and flight

HEALTH ALERT CARD

(Source : MOH 2014)

HOME ASSESSMENT TOOL

(Source : MOH 2014)

REFERENCES
1. Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S,
Al-Barrak A, et al. 2013. Epidemiological, demographic, and
clinical characteristics of 47 cases of Middle
East
respiratory syndrome coronavirus disease from Saudi
Arabia:
a descriptive study. Lancet Infect. 13(9):752-61.

2. Breban R, Riou J, Fontanet A. 2013. Interhuman

transmissibility of Middle
East respiratory syndrome
coronavirus: estimation of pandemic risk. Lancet.
382(9893):694-9.

3.Buchholz U, Mller MA, Nitsche A, Sanewski A, Wevering N,

Bauer-Balci T, et al. 2012. Contact investigation of a case of
human novel coronavirus
infection treated in a
German
hospital.

REFERENCES
4. ECDC 2014. Severe respiratory disease associated with Middle
East Respiratory Sydrome Coronavirus (MERS-CoV).
http://
www.ecdc.europa.eu/en/publications/Publications/mers-covsevere-respiratory-disease-risk-assessment-16-october-2014.
pdf
(Access on 16 Disember 2014 ).
5. Cauchemez S, Van Kerkhove MD, Riley S, Donnelly CA, Fraser
C, Ferguson NM. 2013.Transmission scenarios for Middle East
Respiratory Syndrome Coronavirus (MERS-CoV) and how to
tell them apart. Euro Surveill [Internet].
18(24).

6. Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, EschbachBludau M, et al. 2012. Detection of a novel human coronavirus
by real-time reverse- transcription polymerase chain reaction.
Euro Surveill. 17(39):pii=20285.

REFERENCES
7. Jadav H.A. 2013. Middle East Respiratory Syndrome Corona
Virus (MERS- CoV) : A Deadly Killer. Journal of Pharmacy and
Biological Sciences . Volume
8, Issue
5 , PP74-81.
www.iosrjournals.org. (Access on 16 Disember 2014).
8. Li W, Shi Z, Yu M, Ren W, Smith C, Epstein JH, et al. 2005. Bats
are natural
reservoirs of SARS-like coronaviruses. Science.
310(5748):676-9.

9. Memish ZA MN, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, et al.
2013.Middle East respiratory syndrome coronavirus in bats,
Saudi Arabia. Emerg Infect .
10. Ministry of Health. 2014. Maklumat terkini berkaitan
jangkitan Middle East
Respiratory Syndrome Coronavirus (MERS-CoV). Wilayah
Persekutuan Putrajaya. 10 Disember 2014.

REFERENCES
12. Muller MA, Raj VS, Muth D, Meyer B, Kallies S, Smits SL, et
al. 2012. Human
coronavirus EMC does not require the SARS-coronavirus
receptor and maintains broad replicative capability in
mammalian cell lines. MBio. 3(6). pii: e00515-12. doi:
10.1128/mBio.00515-12.

13. Perera RA, Wang P, Gomaa MR, El-Shesheny R, Kandeil A,

Bagato O, et al.
2013. Seroepidemiology for MERS coronavirus using
microneutralisation and pseudoparticle virus neutralisation
assays reveal a high prevalence of antibody in
dromedary camels in Egypt. Euro Surveill

14. Reusken C, Mou H, Godeke GJ, van der Hoek L, Meyer B,

Muller MA, et al. 2013. Specific serology for emerging human
coronaviruses by protein
microarray.
Euro Surveill. 18(14):
20441.

REFERENCES
15. WHO. 2013. Guidelines for investigation of cases of human
infection with middle
east respiratory syndrome cornavirus
(MERS-CoV). http://www.who.int/csr/disease/coronavirus
infection/MERS CoV in investigation guideline Jul13.pdf.
(Access on 16 Disember 2014).
16. Zaki AM, Van Boheemen S, Bestebroer TM, Osterhaus
AD,Fouchier RA. 2012.Isolation of a novel coronavirus from a
man withpneumonia in Saudi
Arabia. N Engl J Med.
367(19):1814-20.

Thank You