MERS-CoV first reported in Saudi Arabia

The Rajiv Gandhi Centre for Biotechnology (RGCB) here has launched the surveillance for the Middle East Respiratory Syndrome Corona virus (MERS-CoV), which was first reported in Saudi Arabia and is now slowly spreading to other countries like the U.K., Jordan, France, and Tunisia.

Strange enough, despite the fact that Kerala has a lot of women working in the health sector in the Middle East and that there is good traffic between the Middle East and Kerala, active surveillance for the illness has not yet been launched.

The Union Health Ministry did sound a general alert to the State Health authorities on the developing picture of the MERS-CoV and about the need for surveillance. But there has been no official word from the WHO on the need for ‘active’ surveillance, senior Health officials said.

The infection is still being reported in small clusters, even outside Middle East countries and hence no screening at airports has been advised by WHO. Yet, given Kerala’s widespread links to the Middle East and the fact that so many Malayalis live in very crowded environs in these countries, it is very much possible that the virus could come into Kerala, warns M. Balaraman Nair, former Professor of Pathology and the Chairman of the Health Policy panel.

RGCB launched the surveillance on its own after closely following the global alerts being issued by the World Health Organisation, R. Radhakrishnan, Head of Laboratory Medicine, RGCB, told The Hindu.

Human-to-human transmission of the virus has been confirmed with many cases being reported among family members and through hospital-acquired (nosocomial) infections. The virus has so far resulted in 40 confirmed cases of severe respiratory disease, including 20 deaths.

“As soon as the WHO issued its second global alert on CoV in January, we had acquired the lab reagents and prepared ourselves to do the PCR test for the virus. We have so far tested nearly 30 samples of bronchial lavages (fluids from the lower respiratory tract) from patients with acute respiratory illness in the intensive care units, who have a recent travel history to the Middle East and who do not present the clinical picture of H1N1 flu. Almost all samples are being sent from the private sector,” Dr. Radhakrishnan said.

The MERS-CoV belongs to the same family as the SARS virus, which had erupted as a major global outbreak in 2003. The novel CoV, however, though more lethal than SARS virus, does not spread from humans as easily as SARS.

Till now, all the confirmed cases of MERS-CoV has had some link to the Middle East – persons who travelled to the destination, their close family members, or health workers who came into contact with confirmed cases in hospitals.

According to WHO, half of all confirmed cases have died. Complications during the course of the illness included severe pneumonia with respiratory failure requiring mechanical ventilation, acute respiratory distress syndrome, and multi-organ failure. A number of cases have also had gastrointenstinal symptoms during the illness.

WHO has also stated that there are still many unanswered questions about the MERS-CoV — how did the infection originate in Saudi Arabia; what is the reservoir for the virus; what is the mode of transmission for the virus from person to person and the clinical spectrum of the infection.

Swabs from the nose or throat, as in the case of H1N1 may not be sensitive enough for testing.

Lower respiratory specimens like sputum or bronchial lavage are more likely to give accurate results.

The European Centre for Disease Prevention and Control (ECDC), in its Rapid Risk Assessment statement issued on May 17, has indicated that underlying conditions and immunosuppression could increase the vulnerability of CoV-infected the patient. It also points out about the possibility that patients may not initially present with respiratory symptoms, something which doctors should be alert about.

“At present, we have limited information on how the virus presents itself. But going by the fact that all confirmed cases of MERS-CoV have had some link to the Middle East, it is time that the Health Department issued an alert to all doctors and health field workers to keep a close watch on patients with any respiratory illness, who might have a recent travel history to the Middle East,” a public health official said.