GlobalHealth Threats

MERS-CoV in healthcare settings: Challenges and Concerns

The World Health Organization (WHO) has reported that the transmission of Middle-East respiratory syndrome coronavirus (MERS-CoV) within a healthcare setting is of grave concern. In the latest WHO MERS Global Summary and Assessment of Risk, experts noted that healthcare-associated infections occur more frequently where there is a lack of awareness of the disease MERS. Additionally, identification of cases is sometimes delayed due to symptoms being misdiagnosed. These factors have contributed to increased human-to-human transmission, especially within a healthcare setting.

The last global update was published in June 2018. Since then, at least 219 laboratory-confirmed cases of MERS-CoV have been reported from four countries. These include Saudi Arabia (204), Oman (13), Republic of Korea (1) and the United Kingdom (1). Of the cases reported, 97 were secondary infections and 52 cases were linked to transmission within a healthcare setting. These cases involved health care workers, patients sharing rooms/wards with other patients or family visitors.

In Saudi Arabia, outbreaks occurred in six healthcare facilities and human-to-human spread occurred within two of them. In April, one of two unlinked clusters in Al-Khafji city resulted in 10 cases, 5 of them involving healthcare workers.

In Oman, two unrelated clusters were reported in January and February. These clusters included cases among healthcare workers.

WHO experts specified that there have been no changes in disease transmission patterns – most infections were linked to dromedary camels and many secondary cases occurred in healthcare settings. Household transmission among close members of the family was limited and remains unexplained. Outbreaks in hospitals occur often, and although they aren’t usually large outbreaks, they can affect several healthcare facilities. The risk of exported cases to areas outside of the Middle East due to travel remains significant.

The exact modes of transmission in health care settings are still unclear and these are being researched further in the affected countries. Some studies have indicated that transmission in health care settings has occurred due to inadequate infection prevention and control procedures and cases were not isolated. Further investigations during the outbreaks indicate that certain procedures conducted in crowded emergency departments or medical wards with insufficient infection prevention and control measures led to human-to-human transmission and environmental contamination.

There is a need for early identification of the disease in the community and healthcare settings, improving compliance in infection prevention and control and adhering to standard precautions of disease prevention to reduce and possibly eliminate human-to-human transmission in health care facilities. [SOURCE-WHO]