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Transcript of Buletin 42014
1
From Middle East to Malaysia
If you have any queries with regards to drugs / health, feel free to
contact us at :
Drug Information Service (DIS), Pharmacy Department HRPZ II
09-7452000 Ext: 2478 (Office hours)
Edisi Mac 2014
2
»Introduction………………………………………………………………...3-4
»Frequently Asked Question & Answers ……………………..5-7
»Interim Guidance For Health Profesional………………….8
»Interim Homecare and Isolation Guidance for MERS-COv ………….9
»Prevention Steps for Infected Person……………………....10
»Prevention Steps for Caregivers & Household………...11
»Hajj and Umrah ……………………………………………………….12-13
»News on MERS-COv …………………………………. ……………14-15
»Tips for those visiting Middle East Countries………...16
CONTENTS
From left: Lian Ka Heng, Muhammad Qaliff Muhd Zaki, Nur Ain Mohd Tajudin, Nadwanie Harniza Ibrahim, Hanis Sadikin Abd Hadi, Ng Chun Shian, Heng Chin Yi, Moo Chee How.
Not in the picture: Tinoshini A/P Silvakumer, Raja Nurul Fatin Raja Kamaruzaman
TEAM EDITORS
ADVISOR
Puan Fatimah Abdullah
Ketua Farmasi Farmasi
Puan Sudarwaty Abd Rajab
Pegawai Farmasi U48
Puan Aziani Yacob
Pegawai Farmasi U44
CHIEF EDITOR EDITOR
3
MERS-COV (Middle East Respiratory Syn-
drome Coronavirus), previously known as the
Novel Coronavirus or SARS-like virus, is a
member of the coronavirus family. It was
named by the Coronavirus Study Group of the
International Committee on Taxonomy of
Viruses in May 2013
MERS Coronaviruses commonly cause res-
piratory illness in mammals, including hu-
mans. Coronaviruses are responsible for ap-
proximately 1 in every 3 cases of the common
cold. MERS-CoV is much more deadly than
any coronavirus seen before.
As of 18 December 2013, eleven countries have now reported cases of human infection with MERS-CoV
particularly in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates,
and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Mid-
dle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in
people who had not been to the Middle East but who had been in close contact with laboratory-confirmed
or probable cases.
4
Common symptoms are acute, serious respir-
atory illness with fever, cough, shortness of
breath and breathing difficulties. Most pa-
tients have had pneumonia. Many have also
had gastrointestinal symptoms, including di-
arrhoea. Some patients have had kidney fail-
ure.
In people with immune deficiencies, the dis-
ease may have an atypical presentation. It is
important to note that the current understand-
ing of illness caused by this infection is based
on a limited number of cases and may change
as we learn more about the virus.
5
What do you should know about MERS-CoV???
How widespread is Respiratory Syndrome Coronavirus (MERS-CoV)?
How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely
monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or
pneumonia. WHO will continue to share information as it becomes available.
How do people become infected with this virus?
We do not yet know how people become infected with this virus. Investigations are underway to determine the
source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pat-
tern and course of disease.
How is the virus being transmitted to humans?
We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people
occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure.
More investigations are needed to look at the recent exposures and activities of infected humans. WHO is
working with partner agencies with expertise in animal health and food safety, including FAO, OIE and na-
tional authorities, to facilitate these investigations. Many technical organizations are offering their expertise to
assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols
and guidelines for dealing with new cases are available on the WHO website.
6
How is the virus being transmitted to humans?
We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs
through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investi-
gations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner
agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate
these investigations. Many technical organizations are offering their expertise to assist ministries responsible for hu-
man health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases
are available on the WHO website.
Should people avoid contact with animals or animal products?
Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice
on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided and basic hy-
giene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling
animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or
undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms
that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are
safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other
hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.
Are bats the source of the virus?
MERS-CoV has recently been found to be genetically related to a virus identified in bats from Southern Africa. But
there is no definitive evidence that MERS-CoV originates in bats.
7
Can the MERS-CoV persist in the environment?
We do not yet know the answer to this question. Some types of environment are better suited for persistence of
certain viruses but we still do not know exactly how well and under what conditions MERS-CoV may persist in
the environment.
Is there a vaccine or treatment for MERS-CoV?
No. No vaccine is currently available. Treatment is largely supportive and should be based on the patient’s clini-
cal condition.
Are health workers at risk from MERS-CoV?
Yes. Transmission has occurred in health-care facilities, including spread from patients to health-care providers.
WHO recommends that health-care workers consistently apply appropriate infection prevention and control
Can the virus be transmitted from person to person?
Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred.
These clusters have been observed in health-care facilities, among family members and between co-
workers. However, the mechanism by which transmission occurred in all of these cases, whether respira-
tory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environ-
ment by the patient, is unknown. Thus far, no sustained community transmission has been observed.
8
A patient under investigation (PUI) is a person with the following characteristics:
fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence);
AND EITHER
history of travel from countries in or near the Arabian Peninsula1 within 14 days before symptom onset;OR
close contact2 with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia)
within 14 days after traveling from countries in or near the Arabian Peninsula;OR
is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization)
of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.
Clusters of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization)
should be evaluated for common respiratory pathogens. If the illnesses remain unexplained, providers should
consider testing for MERS-CoV, in consultation with state and local health departments.
Healthcare professionals should immediately report to their state or local health department any person being
evaluated for MERS-CoV infection as a patient under investigation (PUI). Health departments should immedi-
ately report PUIs to CDC using the MERS PUI short form provided in CDC website.
Health departments should send completed investigation short forms by FAX to CDC at 770-488-7107 or attach
the short form to an e-mail to [email protected] (subject line: MERS Patient Form).
To date, little is known about the pathogenic potential and transmission dynamics of MERS-CoV. To increase
the likelihood of detecting MERS-CoV infection, CDC recommends collecting multiple specimens from differ-
ent sites at different times after symptom onset.
Many state health department laboratories are approved for MERS-CoV testing using CDC’s rRT-PCR assay.
Appropriate infection-control measures should be used while managing patients who are PUIs or who have probable or
confirmed MERS-CoV infections
Healthcare professionals should carefully monitor for the appearance of fever and respiratory symptoms in any person
who has had close contact2 with a confirmed case, probable case, or a PUI while the person was ill.
If fever and respiratory symptoms develop within the first 14 days following the contact, the individual should be evalu-
ated for MERS-CoV infection.
Who Should Be Evaluated?
Clusters of Respiratory Illness in Which MERS-CoV Infection Should Be Considered
Reporting Patients Under Investigation (PUIs)
Laboratory Testing
Infection Control
Management of Contacts
9
People who are being evaluated for MERS-CoV infection and do
not require hospitalization for medical reasons may be cared for
and isolated in their home. Isolation is defined as the separation
or restriction of activities of an ill person with a contagious dis-
ease from those who are well.
Before the infected Person
is Isolated at Home...you
must:
Assess whether the home
is suitable and
appropriate for isolating
the ill person.
The house should have
a functioning bathroom
that only the ill person
and household mem-
bers use.
The ill person
should have his or
her own bed and
preferably a private
room for sleeping.
Basic amenities, such as heat,
electricity, potable and hot
water, sewer, and telephone
access, should be available
If the home is in a multiple-
family dwelling, such as an
apartment building, the area in
which the ill person will stay
should use a separate air-
ventilation system, if one is pre-
sent.
There should be a primary
caregiver who can follow
the healthcare provider’s
instructions for medica-
tions and care.
Interim Home Care and Isolation Guidance for MERS-CoV
10
Separate yourself from other people
in your home
As much as possible, you should stay in a different room from other people in your home. Also, you
should use a separate bathroom, if available.
Call ahead before visiting your doctor
Before your medical appointment, call the healthcare provider and tell him or her that you may have
Wear a facemask
You should wear a facemask when you are in the same room with other people and when you visit a
healthcare provider.
Cover your coughs and sneezes
Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into
your sleeve.
Wash your hands
Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sani-
tizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your
eyes, nose, and mouth with unwashed hands.
Avoid sharing household items
You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items
with other people in your home. After using these items, you should wash them thoroughly with soap
and warm water.
11
Place all used gloves, gowns,
facemasks, and other contam-
inated items in a lined con-
tainer before disposing them
Prevention Steps
for Caregivers
and Household
Members Help the ill person
follow the healthcare
provider's instruc-
tions for medication
Have only people in
the home who are es-
sential for providing
care for the ill person.
Other household
members should
stay in another
home or place of
residence.
Restrict visitors who do
not have an essential
need to be in the home.
Keep elderly people and
those who have compro-
mised immune systems or
specific health conditions
The home have
good air flow
Wear a disposable facemask,
gown, and gloves when you
touch or have contact with the
ill person’s blood, body fluids
and/or secretions.
Avoid sharing
household items.
Wash your hands often and
thoroughly with soap and wa-
ter
Clean all “high-touch” sur-
faces, such as counters, tab-
letops, doorknobs, bath-
room fixtures, toilets, and
Wash laundry
thoroughly.
Wear disposable gloves while
handling soiled items.
12
Spreads:
By close contact
By air
Sites of known cases
Mecca, Saudi Arabia
(origin of MERS):
Site of annual Hajj and Umrah
Overcrowding sets perfect condi-
tions for the spread of MERS
13
Saudi Government Initiatives
Visas
down
by 20%
per
country
Health
workers
up by
3,000 to
22,000
total
Elderly, children, pregnant
women and those with chronic
medical illness were discour-
aged from participating in Hajj.
Saudi Arabia, Ministry of Health Guidelines
Wear facemasks
Wash hand thoroughly after sneezing or coughing
Use disposable tissues
Avoid direct contact with infected person
Avoid touching eyes, nose or mouth
Pilgrims returning from Hajj are advised to seek medical
attention if they developed MERS like symptoms within
14 days after their trip.
Hajj 2013:
Number of pilgrims dropped by
approximately 1 million due to
MERS.
No outbreak of MERS &
only a handful of cases
reported.
International
pilgrims
down by
21%
Local
pigrims
14
News on MERS– COv
Most MERS cases going undetected, 'slow epi-
demic underway': study November 12, 2013. A new analysis of MERS case data sug-
gests a large number of infections are going undetected, with
the researchers estimating that for each case that has been
found, five to 10 may have been missed.
THESTAR.COM
June 20, 2013. A mysterious new respiratory virus that originated in the Middle East spreads easily be-
tween people and appears more deadly than SARS. A patient who was receiving dialysis treatment spread MERS to seven others, including fellow dialysis pa-
tients at the same hospital. During SARS, such patients were known as “superspreaders” and effectively
s e e d e d o u t b r e a k s i n n u m e r o u s c o u n t r i e s .
But MERS appears far more lethal. Compared to SARS’ 8 percent death rate, the fatality rate for MERS
in the Saudi outbreak was about 65 percent, though the experts could be missing mild cases that
might skew the figures.
New Straits Times
MERS virus has infected camels since 1992
February 26, 2014. Scientists say the mysterious MERS virus has been infecting camels
in Saudi Arabia for at least two decades and early human cases probably went undiagnosed.
Since the Middle East respiratory syndrome coronavirus was first identified in 2012, doctors
have struggled to explain how many patients have fallen sick. MERS can cause symptoms
including fever, breathing problems and kidney failure. To date, it has infected more than
180 people and killed 79, mostly in the Middle East, though infections have also spread
to Europe and northern Africa.
New MERS virus spreads easily, deadlier than
SARS
15
February 25, 2014. In a startling revelation,
researchers have found the deadly coronavirus
responsible for Middle East Respiratory Syn-
drome (MERS) - among camels.
MERS, a serious viral respiratory illness, has
been identified in 182 people since 2012,
according to the World Health Organisation
(WHO). Nearly 79 people have died from the
condition. Efforts to identify an animal source
of infection have focused on bats and camels
as the first known case of MERS was in a Saudi
Arabian man who had four pet camels.
In a study, investigators from the US and Saudi
Arabia conducted a comprehensive survey of
camels throughout Saudi Arabia. They collected
blood samples and rectal and nasal swabs from
camels, sheep and goats in November and De-
cember of 2013.Overall, 74 percent of camels sampled countrywide had antibodies to MERS-CoV.
More than 80 percent of adult camels throughout the country had antibodies to the virus.
The researchers also found that active virus was frequently detected in nasal swabs in 35 percent of
young camels and 15 percent of adult camels countrywide.
It was less frequently found in rectal swabs and not in blood, indicating that the virus most likely is
spread by respiratory secretions.
Malaysia Sun
CAMELS carry deadly virus
TH medical team ready for MERS threat
MAKKAH: The Pilgrims Fund Board (Tabung Haji) health and medical teams here and in Medina are ready to face the Novel corona virus or Middle East Respiratory Syndrome Corona virus (MERS-CoV) pandemic.
September 27, 2013. Malaysian Haj Delegation (Medical) deputy
head Dr Mohamad Faid Abdul Rashid said the Tabung Haji teams
were well-equipped to handle the situation, in the event of an epi-
demic.
New Straits Times
16
Tips for those visiting
Middle East countries
June 8, 2013. Health Ministry director-general Datuk Dr Noor Hisham Abdullah said the dis-
ease had spread in a few countries in the Middle East and Europe. However, the World
Health Organisation had not issued any travel advisory against going to the affected coun-
tries.
"The ministry has outlined several precautionary measures to those who wish to visit the af-
fected countries, especially those who will be travelling there to perform their haj or umrah."
Visitors were advised to wash their hands frequently with soap and water or hand sanitisers
especially after coughing, sneezing or shaking hands."Always carry a mask and hand sanitis-
ers, and avoid eating uncooked or raw food. Make sure fruits are washed before they are eat-
en and drink only treated water."
He said the ministry had not detected the presence of the virus in Malaysia.
"Passengers arriving at the Kuala Lumpur International Airport's arrival hall will undergo a
special screening process."Any cases of respiratory-related illness in the country are also
closely monitored." Dr Noor Hisham added that the ministry had upgraded facilities in hospi-
tals to accommodate patients in the event the virus had been detected.
"The ministry will work closely with Lembaga Tabung Haji to monitor the health of pilgrims
before, during and after their visit."The pilgrims will be briefed about MERS-CoV and the
precautionary measures they will have to take."
MERS-CoV is caused by the coronaviruses. The most common symptoms observed are fe-
ver, cough, shortness of breath and breathing difficulties while atypical symptoms, such as
diarrhoea, have also been seen in patients with immunosuppression.
New Straits Times