Here is all you need to know about Middle East Respiratory Syndrome in Oman

Overview of the situation

A 34-year-old man from Oman's Al Dhahira Governorate was diagnosed with (MERS-CoV) and reported to the World Health Organization (WHO) on April 28, 2022. On the property where he grew up in Oman, his family raised goats, dromedaries and sheep. The case is still in a crucial state of flux. One hundred and seventy-seven health care professionals had been tracked for a period of  14 days after the last time they had been exposed to the case as of April 28. To yet, there have been no reports of any secondary cases.

A synopsis of the situation

A single instance of MERS-CoV was detected in Al Dhahira Governorate in Oman on April 28th, 2022. 

On April 18, a 34-years old male from Al Dhahira Governorate suffered   from dry cough, breath shortness along with high fever. These symptoms continued for a period of six days, during which time he was hospitalised. He was transported to the hospital's emergency room on April 24. He was taken to the isolation ward after being detected with symptomatic pneumonia involving fluid accumulation in his lungs after being discovered to be in significant respiratory distress, feverish, and hypotensive. An urgent transfer to a lower pressure isolation chamber occurred once the patient's condition worsened. Isolation and mechanical ventilation were put in place for him on April 25, when his condition deteriorated further. SARS-CoV along with Mycobacterium tuberculosis were found in respiratory samples. On April 27, a RT-PCR for the MERS-CoV was done as part of a sepsis workup that included included blood and urine testing.

He is still being mechanically ventilated inside an isolation chamber inside the ICU as of 8 May, and his status remains severe. There are no documented co-morbidities for this patient. There had been no previous interaction with such instances, no travel, and no previous hospitalisation. But on his family farm in Oman, the patient was exposed to animals such as dromedaries, lambs, and goats.

The study of the disease's prevalence

MERS is a viral respiratory illness caused by the Middle East Respiratory Syndrome Coronavirus (MERSCV) (MERS-CoV). A substantial fatality rate is associated in MERS-CoV infection. More than a third of MERS patients have died, but it may be an underestimate of the genuine mortality rate. This is becasue mild cases involving MERS-CoV might slip under the radar of surveillance systems. Until we get to know more about MERS-CoV,fatality rates are now only considered for laboratory-confirmed cases. 

The natural vector and the zoonotic vector of MERS-CoV infections, a camel, infects humans through direct or indirect contact.  The MERS-CoV virus has shown that it may spread between humans.The reported quasi human-to-human transmissions have happened thus far among intimate contacts as well as healthcare environments.  Only a few cases of human-to-human transfer have been reported outside of the healthcare industry.

Asymptomatic MERS-CoV infection and moderate respiratory symptoms are on one end of the MERS-CoV infection spectrum, whereas acute severe respiratory illness and mortality are on the other.   Fever, cough, along  with breath shortness are common symptoms of MERS-CoV infection. In most cases, pneumonia is found, albeit this isn't always present. There have also been reports of diarrhoeal symptoms. A severe disease can lead to failure of the respiratory system that necessitates the use of mechanical ventilator and intensive care assistancElderly people, those with compromised immune systems, including people suffering from chronic conditions such as cancer, kidney disease, chronic obstructive pulmonary disease, including diabetes appear to be more vulnerable to the virus's effects.

MERS-CoV particular vaccines and therapies are actively in development, however there is currently no vaccination or particular therapy available. Patients' clinical conditions guide the treatment plan.

Response to public health. 

There were six people in the immediate community including 27 healthcare staff who had been identified as contacts as of April 28th, and they were being monitored for a period of 14 days after their last interaction with the MERS patient.  The Health Ministry's infection control and prevention guidelines for exposures to this virus and cases required RT-PCR screening of all high-risk interactions, such as healthcare personnel. There have been no reports of secondary cases in Oman to yet.

This patient was hospitalised where infection control and prevention, IPC) procedures were in place.

Workers in the healthcare industry were taught on MERS as well as given an IPC refresher course.

In order to avoid the spread of the disease, family members who had been recognised as close associates of the patient were given instruction on proper respiratory and personal hygiene.

The patient's family farms and also farms of close relatives were inspected by the Ministry of Agriculture, and samples from dromedaries were taken for testing. As of 8th May 2022, findings still pending.

The World Health Organization's risk assessment

It is extremely unlikely for someone in Oman to become infected with MERS-CoV. Since June of 2013, only 25 cases including this present one and seven fatalities, were reported by Oman to WHO.

There have been 2591 confirmed MERS-CoV cases and 894 related fatalities reported to WHO as of May 15th, 2022. There have been a large number of cases reported from nations located in Arabian Peninsula. Besides this area,   in May 2015, there was a major epidemic in the Korean Republic with 186 laboratory-confirmed cases and 38 deaths recorded (185 in the Republic of Korea plus 1 in the country of China). To date, the WHO has received reports of lab-confirmed cases including fatalities, which are included in the worldwide total.

Even though one case has been reported, overall risk estimates for MERS has not changed. theMERS-CoV infectious disease cases are expected to be notified from the Mid East as well as other regions where the virus is making the rounds in camels, and cases will be distributed worldwide by people who were exposed to this virus through their contact with camels or products (for example, drinking of camel's raw milk) or in a medical environment in the future.

According on the most up-to-date epidemiological data, the World Health Organization (WHO) is conducting an assessment of risk.

Individuals should follow the guidance of the WHO

Hinging on the present situation and the information that is currently available, WHO reiterates the necessity of strict monitoring by all the Member States regarding acute respiratory illnesses, particularly MERS-CoV, and the thorough examination of any atypical patterns.

Keeping healthcare facilities safe from the spread of disease: There have been delays in detecting the early signs of  infection by MERS-CoV, poor triage of clinically suspected patients, and lags in adopting IPC measures due to human-to-human transfer of MERS-CoV in hospital settings. Since the transmission of MERS-CoV might occur in health care institutions, IPC precautions are essential.

Standard precautions should be used consistently by all healthcare practitioners with each and every patient, in all settings:

• If a patient has signs of an acute respiratory illness, further measures such as droplet precautions must be used.
• Patients with MERS-CoV infection should be treated with additional care, such as hand washing and wearing protective eyewear.
• Work in environments wherein aerosol-generating processes are being performed or where airborne precautionary steps are needed.
• Prevention of disease transmission of MERS-CoV can be achieved by the use of control and prevention methods in healthcare institutions, as well as public health education and awareness campaigns.

People with chronic medical illnesses such as renal failure ,diabetes, and chronic obstructive pulmonary disease, or immunodeficiency tend to be more susceptible to MERS-CoV infection and have a more severe disease. When going to farms, marketplaces, or barns where this virus may be present, those with preexisting medical issues should stay away from close contact with animals such as dromedary camels. Patients with MERS need to get effective, timely as well as safe supportive care, particularly those who are at risk of developing more severe illness.

Hand washing prior to and following contact with animals, as well as preventing contact with ill animals, should indeed be followed to as part of general infection prevention practices in the community. It is important to adhere to food safety guidelines. Camel milk and urine should not be consumed raw, and people should not eat meat that hasn't been properly prepareWorld Health Organization (WHO) has not recommended any trade or travel restrictions as a result of the MERS-CoV outbreak in the Middle East and North Africa (MENA).