WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 7 June 2014]

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 7 June 2014]
:: Ebola virus disease, West Africa – update 4 June 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 4 June 2014

WHO concludes a MERS-CoV risk assessment mission in the United Arab Emirates
6 June 2014
A team from the WHO and technical partners from the Global Outbreak Alert and Response Network (GOARN) has concluded a 5 day mission in United Arab Emirates (UAE).
The team assessed the risk posed by the Middle East respiratory syndrome coronavirus, or MERS-CoV in the country. The team consisted of 6 experts in coordination, epidemiology, infection prevention and control, food safety and the human-animal interface, and risk communication.

Health authorities in the UAE had invited WHO to review the current situation after an upsurge in MERS-CoV infections in April. Upon arrival, the WHO team met with H.E Mr Abdul Rahman bin Mohammed Al Owais, the Minister of Health, in Dubai to discuss the mission.

Investigation and evaluation
During the mission, the team had extensive meetings with experts from Health Authority Abu Dhabi, Dubai Health Authority and the Abu Dhabi Food Control Authority. The team visited the hospital to which two-thirds of the country’s cases can be traced, in order to review the epidemiological investigation and assess the infection prevention and control measures that have been applied. The WHO team evaluated the work done on investigating possible exposure routes, transmission patterns, and the clinical situation.

“We are impressed by the amount of data and information generated during the investigation of MERS cases by UAE to help better understand MERS- CoV. This knowledge is of utmost importance to the rest of the world to better discover the source of the virus and the routes of transmissions from animals to humans, “said Peter Ben Embarek, WHO team leader.

“The UAE health authorities have been following up diligently on the MERS-CoV cases, including repeated laboratory testing to check when cases have been cleared of the virus. This data will make an important contribution to the risk assessment and to guide the health response internationally,” Ben Embarek concluded.

Need to share experience and knowledge
The preliminary result of the mission indicates that the cases in UAE do not show evidence of sustained human to human infection. The recent upsurge of cases in Abu Dhabi appears to have been caused by a combination of factors, including a breach in infection prevention and control measures in health care settings, active surveillance and increase in community acquired cases…


WHO: World travel advice on MERS-CoV for pilgrimages [Umra and Hajj]
3 June 2014
I. Introduction
…The virus appears to be circulating widely throughout the Arabian Peninsula and most MERS cases have been reported by the Kingdom of Saudi Arabia. While most cases have occurred among residents, some cases have occurred among visitors. Based on currently available information, the overall risk for visitors to acquire MERS infection appears to be low.
The currently known epidemiological patterns indicate some infections occur in communities. Cases detected in the community may arise from contact with infected animals or unprocessed products from infected animals, from person-to-person spread in the community, or from acquisition in the healthcare setting by individuals who remained living in the community. Studies are underway to determine the relative contribution of all of these, but the studies are not yet complete. Other infections have occurred in hospitals, primarily when hospitalization of an infected patient, coupled with suboptimal infection control and prevention practices, has led to hospital transmission and outbreaks. Finally, infection among families has been seen and may reflect either person to person transmission or possibly exposure to a common source. At this time, the understanding of how MERS is transmitted is not complete, and we await the results of the studies in progress. There is no information at this time to suggest that widespread transmission is occurring in communities.
Since April 2014, there was an increased number of cases, notably in the Kingdom of Saudi Arabia and in the United Arab Emirates in both communities and health care setting. The latest information on MERS-CoV can be found here:
II. Effective communication of risk information
It is important for countries to use all practical and effective means possible to communicate information on a range of issues before, during and after Umra and Hajj to all key groups, including the following:
:: travellers to Umra and Hajj, particularly vulnerable groups within this population;
:: public health officials;
:: health care staff responsible for the care of ill pilgrims;
:: transportation and tourism industries; and
:: the general public.
[Text continues with specific recommendation for country actions before, during and after Umra and Hajj]
III. Measures at borders and for conveyances
WHO does not recommend the application of any travel or trade restrictions or entry screening.
WHO encourages countries to provide information on MERS and this travel advice to transport operators and ground staff, and about self-reporting of illness by travellers.
As provided by the IHR, countries should ensure that:
:: routine measures are in place at point of entry for assessing ill travellers detected on board conveyances (such as planes and ships) and at entry;
:: procedures and means are in place for communicating information on ill travellers between conveyance and points of entry as well as between points of entry and national health authorities;
:: safe transportation of symptomatic travellers to hospitals or designated facilities for clinical assessment and treatment is organized….