Thursday, May 22, 2014

Prevention is the best medicine for MERS virus

With more than 1 million Indonesians working in the Middle East and 500,000 others visiting Saudi Arabia every year for the haj and umrah (minor pilgrimage), Indonesia is potentially at risk of the Middle East respiratory syndrome (MERS) coronavirus.

It was first reported in Saudi Arabia in 2012 after laboratory examinations of sputum samples from patients who fell ill in an outbreak of flu revealed a new virus. Since then, MERS cases have been reported in several countries, including 62 suspected cases in Indonesia. So far, all the cases have been linked to countries on the Arabian Peninsula. Strains of MERS that match human strains have been isolated in camels from Egypt, Qatar and Saudi Arabia. Studies have found MERS antibodies in camels across Africa and the Middle East.

Lessons can be learned from the 1918 flu pandemic, the first to have involved the H1N1 influenza virus. It infected 500 million people across the world and killed 50 million of them. In the global pandemic, the transmission of the influenza virus was very rapid and the fatality rate was high.

Severe acute respiratory syndrome (SARS) also taught us a lesson. Like MERS, SARS is a viral respiratory disease of zoonotic origin. It was caused by the SARS coronavirus. In 2002, an outbreak of SARS infected 8,273 people, killing 775 of them across the globe, according to the World Health Organization (WHO). Like the 1918 flu pandemic, the transmission was very acute, taking place in less than a month.

We can also take a message from Contagion, a science fiction film directed by Steven Soderbergh in 2011, which portrays the story of a flu epidemic of zoonotic origin that is sustained by human-to-human transmission.

The WHO stated in February 2013 there was no evidence of sustained human-to-human transmission of MERS. The world body warned that the virus was a “threat to the entire world”, but it stopped short of issuing travel warnings for people visiting the Middle East. Indonesia, the world’s largest predominantly Muslim country, has not given travel warnings to those traveling to the Middle East either.

Viral respiratory diseases, including MERS, SARS and swine flu, occur seasonally and pose a serious threat once the virus transmits from human to human. Therefore, prevention is the key to fighting such viruses.

The Health Ministry should strengthen monitoring, especially at arrival points for pilgrims returning from the Middle East such as airports or harbors. There should be thermal detectors in every airport or harbor to detect flu symptoms in those coming from the Middle East. Health officials in those areas should be aware of every person with flu symptoms. Indonesians returning from pilgrimages should tell health officials if they are suffering from symptoms of flu. The government should continue to increase awareness concerning MERS, including among pilgrims.

The MERS virus is most likely to be transmitted through close contact and inhalation. So, all health workers are prone to the disease. Awareness programs should, therefore, extend to hospitals and medical workers. There have been cases of virus transmission in healthcare facilities in several countries, particularly from patients to healthcare providers.

Given the difficulty of detecting patients with MERS in early phases without lab tests, it is important for health workers to apply universal precautions to all patients. According to the WHO, droplet precautions should be added to standard procedures when providing care to patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added to standard operating procedures when treating suspected or confirmed cases of MERS infection. Patients with flu-like illnesses should be told to avoid coughing or sneezing in front of others.

The Health Ministry should advise travelers who develop a significant acute respiratory illness with fever and cough within two weeks after their return from the Middle East to minimize their contact with others to prevent virus transmission. They should discard tissues after use, wash their hands regularly and report to medical staff as soon as they display symptoms.

Cooperation between the WHO and Middle Eastern countries should be initiated to gather information and resources on how to prevent and handle this potential threat.

Prevention of zoonotic transmission is key. It should prompt coordination between the Health Ministry and the Agriculture Ministry to find ways of minimizing the spread of the disease from animals to humans.

When undertaking pilgrimages, Indonesians are advised to practice general hygiene, which includes regular hand washing after touching animals and avoiding contact with sick animals. If necessary, Indonesians should avoid visiting camel farms and markets.

If MERS develops into a big outbreak in the Middle East, the Indonesian government should announce a travel warning as soon as possible, including for haj and umrah pilgrims.

No vaccine or specific treatment is currently available for infected patients. Treatment is supportive and based on the patient’s clinical condition.

So, it is better to prevent it.

The writer
Tommy Dharmawan, Jakarta | is a medical doctor who lives in Jakarta.


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