Emergencies preparedness, response

Middle East respiratory syndrome coronavirus (MERS-CoV) – Jordan

Disease outbreak news
1 October 2015

Between 21 and 23 September 2015, the National IHR Focal Point of Jordan notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

  • A 29-year-old, male health care worker from Amman city developed symptoms on 15 September. After attending the emergency room of the hospital where he works, the patient was treated symptomatically and sent home. The patient, who has comorbidities, tested positive for MERS-CoV on 20 September and was admitted to hospital. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient provided care to a laboratory-confirmed MERS-CoV case (see DON published on 18 September – case no. 2). He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
  • A 60-year-old male from Amman city developed symptoms on 10 September and, on 15 September, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 20 September. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient visited a hospital in which a laboratory-confirmed MERS-CoV case had received care. Investigation of possible epidemiological links with the hospitalized MERS-CoV case or with the health care workers who took care of the case is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
  • A 69-year-old female from Amman city was admitted to hospital on 7 September due to a cardiovascular condition. The patient, who had comorbidities, was discharged from hospital on 16 September. On 17 September, she developed symptoms and, on the same day, was admitted to another hospital. The patient tested positive for MERS-CoV on 22 September and, on the same day, passed away. Investigation of possible epidemiological links with the MERS-CoV case in the first hospital or with shared health care workers is ongoing. The patient had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
  • A 39-year-old, female health care worker from Amman city, who was identified through contact tracing, tested positive for MERS-CoV while asymptomatic on 23 September. Currently, she is still asymptomatic in home isolation. The patient, who has no comorbidities, provided care to a laboratory-confirmed case (see DON published on 18 September – case no. 2). She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.

Contact tracing of household and healthcare contacts is ongoing for these cases.

Globally, WHO has been notified of 1,593 laboratory-confirmed cases of infection with MERS-CoV, including at least 568 related deaths.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.

Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.

Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

Public health authorities in host countries preparing for mass gatherings should ensure that all recommendations and guidance issued by WHO with respect to MERS-CoV have been appropriately taken into consideration and made accessible to all concerned officials. Public health authorities should plan for surge capacity to ensure that visitors during the mass gathering can be accommodated by health systems.