Middle East Respiratory Syndrome

 

Ms. Indu Rathore

Assistant Professor, Murari Lal Memorial School & College of Nursing, Village- Nagali, P.O. Oachghat, Solan (HP)- 173223

 

ABSTRACT:

Emerging and re-emerging infectious diseases has no fixed geographical boundaries. They often result in high morbidity, death rate and contribute to significant socio-economic burden. Middle East Respiratory Syndrome (MERS) is an emerging respiratory tract infection of the human beings caused by Middle East Respiratory Syndrome Coronavirus (or MERS-CoV). It has raised the panic and concern among the masses in the Middle East countries in the previous years. Camels are considered to be a major animal reservoir and source of infection in humans. The human-to -human transmission has been reported through close contact with an infected person, inadequate prevention and control measures in healthcare facilities. The incubation period of MERS-CoV ranges between 2-14 days. The typical clinical case presentation of MERS is fever, cough, and/or shortness of breath. Severe cases may develop respiratory failure and death. CDC recommends molecular test (rRT-PCR) for diagnosis and serological test for surveillance or investigation purposes of MERS-CoV. There is no vaccine and specific treatment currently available for MERS. Only symptomatic treatment is given. Nursing interventions include thorough travel assessment, history taking, education, and provision of bed rest, comfort measures, safety, adequate hydration, nutrition, management of fever, cough, diarrhea and other complications.

 

 

 

INTRODUCTION:

Emerging and re-emerging infectious diseases has no fixed geographical boundaries. They often result in high morbidity, death rate and contribute to significant socio-economic burden. Middle East Respiratory Syndrome (MERS) is an emerging respiratory tract infection of the human beings caused by Middle East Respiratory Syndrome Coronavirus (or MERS-CoV).¹

 

The MERS was first reported in the Arabian Peninsula from Saudi Arabia in 2012. Later it was reported in 27 other nations from the Middle East region, Europe, Africa, Asia and the United States of America. Till 2nd December 2016, 1841 laboratory confirmed cases were reported to WHO with around 36% case fatality rate.² MERS-CoV is a zoonotic virus. The exact origin of the MERS-CoV is unknown. From the differential genomic analysis, the virus is found to be originated in bats and then it transmitted to camels in the past. In human beings, MERS-CoV is transmitted from animals. Presently, the route of transmission of the MERS-CoV from animals to humans is not fully clear. Camels are a major animal reservoir and source of infection in humans. The virus does not easily pass from person to person without any close contact. The human-to -human transmission has been reported through close contact with an infected person, inadequate prevention and control standards in healthcare facilities.³ People in close contact with dromedaries (e.g. dromedary owners, farmers, abattoir workers, shepherds, etc.) and health workers caring for MERS patients are at the highest risk of infection.² The incubation period of MERS-CoV ranges between 2-14 days (Median 5 days). ⁴ It is considered that an infected person’s respiratory secretions help in the transmission of the virus from person to person.¹

 

A wide clinical spectrum of MERS-CoV infection may range from asymptomatic or mild respiratory illness to severe acute respiratory disease or even fatal complications including death. The typical clinical case presentation of MERS is fever, cough, and/or shortness of breath. Pneumonia is a common clinical feature, but may not always present. Gastrointestinal symptoms may include diarrhea.  Severe cases may develop respiratory failure and death. The people with weakened immune systems, chronic diseases (e.g. diabetes, cancer), chronic lung disease and the elderly may have serious consequences of MERS. ³

 

CDC (Centre for disease control and prevention) recommends molecular test (rRT-PCR) to diagnose the active infection for presence of MERS-CoV and serological test for surveillance or investigation purposes. Real-time Reverse-Transcription Polymerase Chain Reaction (rRT-PCR) assay detects viral RNA in lower and upper respiratory samples, serum and stool specimen. Serological tests (ELISA, IFA, micro neutralization assay) detect the presence of specific antibodies in serum samples. ⁵ NIV, Pune and NCDC, Delhi will provide facility for diagnosis of MERS in India. ⁶

 

There is no vaccine and specific treatment currently available for MERS. Symptomatic treatment based on the patient’s clinical condition is given. Prevention has been the major aim in managing the patients with MERS. People should practice general hygiene measures after visiting from farms, markets or other places where camels or animals are kept. There should be the avoidance of contact with sick animals. People should not touch their eyes, nose or mouth with unwashed hands. Hand washing should also be emphasized before and after touching animals. People should not consume raw, undercooked and unpasteurized animal products (milk and meat). To avoid cross contamination, uncooked foods should be handled with care. Camel’s meat and milk should be eaten only after pasteurization, cooking or other high temperature treatments. People at risk (immune-compromised persons, diabetes, renal failure and chronic lung disease) should avoid contact with camels, drinking raw camel milk or urine, or eating undercooked meat³. Healthy living habits and health promotion activities such as good personal hygiene, covering mouth and nose while coughing or sneezing, proper hand washing, maintaining distance from affected person, adequate sleep, nutritious food and  plenty of water  help to keep the infection away. Coupled with this, people should avoid crowded places, sharing personal gadgets, handshake or hug to prevent the person-to-person transmission of MERS.⁷

 

WHO encourages all countries for their surveillance and careful observation of unusual patterns of severe acute respiratory infections (SARI) or pneumonia cases. All the countries with huge international travelers from the Middle East and other affected countries should maintain a high degree of alertness. Surveillance along with infection prevention and control standards in healthcare facilities should be extended as per WHO guidelines. All the confirmed and probable cases of MERS should be reported to WHO by the member countries.³

 

Till date, no case of MERS is reported in India. However, due to the transportation of the Haj pilgrimage to Saudi Arabia and international travel from affected countries, may increase the possibility of disease spread in India. The Ministry of Health and Family Welfare, Government of India has already issued the travel advisory for airlines/flights and for traveler’s visiting Saudi Arabia, Republic of Korea and other MERS affected countries. Travel advisory for airlines recommended on several measures to control emerging MERS through international travel such as immediate reporting of sign and symptoms by travelers, stock maintenance (masks, hand sanitizer, disposal bags), assistance  to the health staff (for  contact tracing of the suspected travelers) and aircraft disinfection.⁸ Travel advisory for travelers provides guidance on several useful measures and self health monitoring to be done by traveler’s before leaving India, during travel or stay in affected countries, while and after returning to India.⁷ 

 

Nurses have a vital role to play in health care delivery system. They must prepare themselves to put into the fire first during an alarming situation. They must keep themselves up to date on current statistics, research and factual information on MERS. The official websites and publications of WHO, CDC, NCDC, MOHFW (GOI) etc. are some sources to provide, current and updated information for MERS. Nurses working in hospital and community settings should take a thorough travel history, if a suspected patient exhibits the symptoms of fever and respiratory illness. They should closely monitor the patients travelled to MERS affected countries within the 14 days of onset of symptoms. All the suspected cases should be immediately reported to local health care facility as MERS is a notifiable disease. The patient diagnosed with MERS should be kept in isolation. All the health care workers should follow strict infection control measures (hand hygiene, gloves, gown, mask, goggles) while caring for the patients with MERS.⁹ The other nursing interventions will include provision of bed rest, comfort measures, safety, adequate hydration, nutrition, management of fever, cough, diarrhea and other complications. Nurses should educate to individual, family and community for the prevention of MERS, general hygiene practices and travel safety. 

 

CONCLUSION:

Lack of awareness and under diagnosis due to non-specific MERS symptoms may create fear among the masses. An integrated health care system approach will help to meet the needs of a challenging scenario.

 

REFERENCES:

1.       CDC. Information about Middle East Respiratory Syndrome (MERS) [Internet].[cited 2017Jan14]. Available from: https://www.cdc.gov/coronavirus/mers/downloads/factsheet-mers_en.pdf

2.       WHO.MERS-CoV Global Summary and risk assessment[Internet].[cited 2017Jan14].Available from:http://www.who.int/emergencies/mers-cov/mers-summary-2016.pdf?ua=1

3.       Ministry of Health & Family Welfare-Government of India. MERS Fact sheet [Internet].[cited 2017Jan14]. Available from: http://mohfw.gov.in/showfile.php?lid=3217

4.       CDC. Clinical Presentation[Internet].[cited 2017Jan14].Available from: https://www.cdc.gov/coronavirus/mers/clinical-features.html

5.       CDC. Laboratory[Internet].[cited 2017Jan14].Available from: https://www.cdc.gov/coronavirus/mers/lab/lab-testing.html

6.       NCDC. Government of India. Guidelines on Middle East Respiratory Syndrome Coronavirus (MERS-CoV) [Internet]. [Cited 2017Jan 20]. Available from:http://www.ncdc.gov.in/MERS_CoV_Advisory.pdf

7.       Ministry of Health & Family Welfare-Government of India. Advisory to Travellers who have travelled to Saudi Arabia, Republic of Korea and/or any other affected countries with MERS-CoV infection [Internet] [cited 2017Jan14]. Available from: http://mohfw.gov.in/showfile.php?lid=3216

8.       Ministry of Health & Family Welfare-Government of India. Advisory for Airlines for flights from Saudi Arabia, Republic of Korea and other MERS-CoV affected countries [Internet].[cited 2017Jan14].Available from: http://mohfw.gov.in/showfile.php?lid=3218

9.       Lippincott Nursing Center [Internet]. MERS | NursingCenter. [Cited 2017Jan31]. Available from: http://www.nursingcenter.com/ncblog/june-2015/middle-east-respiratory-syndrome-(mers)

 

 

 

 

Received on 29.03.2017       Accepted on 18.05.2017     

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