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Friday, May 17, 2013

SARS - Was Round 2 ten years in the making?


I'll admit to a little media sensationalism in the title.  Everyone knows about SARS thanks to the 2003 global outbreak.  Not everyone knows that SARS was caused by a Coronavirus and face it - had I started off with Novel Corona Virus (one of our latest viral threats) eyes would glaze over and you may not have read this post!

Similar to the H7N9 Influenza virus that many of us are following closely, the Novel Coronavirus (nCoV) or as it is now officially known  as "Middle East Respiratory Syndrome Coronavirus" (MERS-CoV) is believed to have caused the death of at least 18 people in the Middle East and Europe is cause for concern.  While 18 deaths may not seem significant this in actual fact is roughly half of the laboratory confirmed cases - basically a flip of a coin in deciding life over death. 

It's important to understand, that MERS-CoV is not SARS.  They are both from the same family of viruses and the fact that they are related is certainly a certain in trying to predict the future.  MERS-CoV has been infecting people in the Middle East (Jordan, Qatar, Saudi Arabia and United Arab Emirates) and Europe (UK, Germany and France), however, at this time we still do not know where the virus stems from.  Similar to SARS Coronavirus we saw in 2003, many of people who have become infected develop severe pneumonia.  Of interest with nCoV, many of those that have been infected to date have been older men with underlying medical conditions. 

What we can say is that the clusters that have been seen so far support the fact that person-to-person transmission with close contact with an infected person is occurring.  Transmission does seem to be limited to close contact within small clusters with no indication that the virus has the capacity to sustain generalized transmission within communities.  Nor do we know if other people have or are developing a mild infection and therefore have not had to seek medical attention. 

Most concerning are the questions we have yet to answer such as how people getting infected (from animals? from surfaces? from people through droplet or contact transmission?) and what are the main risk factors?  Genetic testing of MERS-CoV is showing that the virus is similar to bat viruses BUT this similarity does not imply that bats are the reservoir or that direct exposure to bats or bat poop are responsible for infection.   Further, researchers have yet to find MERS-CoV in an animal.

From an infection prevention perspective we do know that Coronaviruses are enveloped viruses meaning in the hierarchy of susceptibility to disinfectants they are among the easiest pathogens to kill.  Ensuring we have a robust cleaning and disinfection program for environmental surfaces and shared patient care equipment and medical devices will help mitigate environmental transmission.  Standard Precautions (Routine Practices) including hand hygiene and the use of Personal Protective Equipment (gloves, goggles, gowns, masks) are of course a cornerstone to any infection control program.  The WHO has developed an Interim Guidance Document for Infection Prevention and control during healthcare for probable or confirmed cases of Novel Coronavirus (nCoV) infection and I know that many of our National and Regional Public Health agencies across North America have been developing and circulating similar guidance documents, screening tools and check lists.

When it comes to our understanding of MERS-CoV there certainly are gaps in our knowledge that will inevitably take time to fill in.  Those who want to keep abreast of the latest findings can do so by following the Global Alert Response (GAR) Updates on the WHO website.  For those of use lucky enough to travel, the next time your seatmate coughs you may want to ask where they've travelled to lately - just don't lean in too close.....


Bugging Off!

Nicole





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