2015-06-01-世界卫生组织-WHO_MERS-CoV_summary_and_risk_assessment_of_current_situation_in_Republic_of_Korea_and_China_-_3_June_2015_4页_422kb

MERS-CoV Summary and Risk Assessment in Korea and China – as of 3 June 2015

Core Content

The document provides a summary and risk assessment of the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in Korea and China as of 3 June 2015. It outlines the global context of MERS-CoV, the current situation in Korea and China, and WHO's recommendations for controlling the outbreak.

Global Context

• Total Cases Reported to WHO: 1179 laboratory-confirmed cases since 2012, with at least 442 deaths.
• Gender and Age Distribution:
  • 66% of cases (n = 1165) are male.
  • Median age is 49 years (range: 9 months to 99 years).
• Countries Affected: 25 countries have reported cases, including Korea and China.
• Majority of Cases: Over 85% of cases have been reported from Saudi Arabia (KSA).
• Newly Affected Countries: Korea and China were newly affected in May 2015.

Situation in Korea and China

• Korea Outbreak:
  • The outbreak started from a single index case who had recently traveled to KSA, Qatar, UAE, and Bahrain.
  • The index case was not symptomatic during travel.
  • As of 3 June 2015, 29 additional laboratory-confirmed cases were identified, with 2 deaths.
  • Transmission occurred to close relatives, patients sharing rooms/wards, and healthcare workers.
  • Limited tertiary transmission (n = 3) was observed.
  • Contact tracing is ongoing, with 1369 contacts being monitored and quarantined.
• China Outbreak:
  • One case was reported in China, who had traveled from Korea to Hong Kong and then to Guangdong.
  • The individual was symptomatic during travel.
  • Chinese authorities have isolated the case and are monitoring contacts in Hong Kong and China.
  • This is the first reported case of MERS-CoV in China.

Risk Assessment

• Transmission Patterns:
  • All known transmission occurred before adequate infection prevention and control measures were in place.
  • Transmission is primarily observed in healthcare settings and among close contacts.
  • Community-wide transmission has not been observed.
• Zoonotic Nature:
  • MERS-CoV is a zoonotic virus, with many cases linked to contact with dromedary camels or camel-related products.
  • Human-to-human transmission is possible, especially in healthcare facilities.
• Outbreak Characteristics:
  • The outbreak in Korea is the largest outside the Middle East.
  • It reflects previous nosocomial outbreaks in the Middle East, where suboptimal infection control led to large numbers of secondary cases.
  • WHO expects additional cases in Korea from contacts of the initial cases before public health measures were implemented.

Recommendations

• Infection Prevention and Control (IPC):
  • Healthcare facilities should implement standard IPC measures for infectious diseases.
  • Rapid screening and assessment procedures should be in place if MERS-CoV is suspected.
  • Droplet precautions, including eye protection, should be used for patients with acute respiratory infections.
  • Linen management, cleaning, disinfection, and waste management are important measures.
  • Airborne precautions are not generally recommended unless aerosol-generating procedures are performed.
• Surveillance and Vigilance:
  • Health workers and facilities should remain vigilant for MERS-CoV, especially among travelers or migrant workers returning from the Middle East.
  • Countries should ensure adequate surveillance according to WHO guidelines.
• Reporting and Research:
  • Member States should rapidly report all confirmed and probable cases, along with exposure, testing, and clinical data.
  • WHO encourages research to better understand how healthcare workers become infected.
• Travel and Trade Restrictions:
  • WHO does not advise special screening procedures at points of entry or travel restrictions related to this event.

Additional Resources

• WHO provides guidelines and tools for investigating MERS-CoV cases, including:
  • Guidelines for investigation of human infection with MERS-CoV
  • Initial Interview Questionnaire for MERS-CoV cases
  • Case-control study to assess risk factors
  • Seroepidemiological investigation of contacts of MERS-CoV patients

Conclusion

The MERS-CoV outbreak in Korea and China represents a significant public health challenge, highlighting the importance of robust infection prevention and control measures in healthcare settings. While the virus is primarily zoonotic, human-to-human transmission has been observed, particularly in healthcare environments. WHO is working closely with Korean and Chinese authorities to monitor and control the outbreak, and is urging continued vigilance and adherence to IPC protocols.