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From Middle East to Malaysia

If you have any queries with regards to drugs / health, feel free to

contact us at :

Drug Information Service (DIS), Pharmacy Department HRPZ II

09-7452000 Ext: 2478 (Office hours)

HRPZIIDIS@gmail.com

Edisi Mac 2014

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»Introduction………………………………………………………………...3-4

»Frequently Asked Question & Answers ……………………..5-7

»Interim Guidance For Health Profesional………………….8

»Interim Homecare and Isolation Guidance for MERS-COv ………….9

»Prevention Steps for Infected Person……………………....10

»Prevention Steps for Caregivers & Household………...11

»Hajj and Umrah ……………………………………………………….12-13

»News on MERS-COv …………………………………. ……………14-15

»Tips for those visiting Middle East Countries………...16

CONTENTS

From left: Lian Ka Heng, Muhammad Qaliff Muhd Zaki, Nur Ain Mohd Tajudin, Nadwanie Harniza Ibrahim, Hanis Sadikin Abd Hadi, Ng Chun Shian, Heng Chin Yi, Moo Chee How.

Not in the picture: Tinoshini A/P Silvakumer, Raja Nurul Fatin Raja Kamaruzaman

TEAM EDITORS

ADVISOR

Puan Fatimah Abdullah

Ketua Farmasi Farmasi

Puan Sudarwaty Abd Rajab

Pegawai Farmasi U48

Puan Aziani Yacob

Pegawai Farmasi U44

CHIEF EDITOR EDITOR

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MERS-COV (Middle East Respiratory Syn-

drome Coronavirus), previously known as the

Novel Coronavirus or SARS-like virus, is a

member of the coronavirus family. It was

named by the Coronavirus Study Group of the

International Committee on Taxonomy of

Viruses in May 2013

MERS Coronaviruses commonly cause res-

piratory illness in mammals, including hu-

mans. Coronaviruses are responsible for ap-

proximately 1 in every 3 cases of the common

cold. MERS-CoV is much more deadly than

any coronavirus seen before.

As of 18 December 2013, eleven countries have now reported cases of human infection with MERS-CoV

particularly in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates,

and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Mid-

dle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in

people who had not been to the Middle East but who had been in close contact with laboratory-confirmed

or probable cases.

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Common symptoms are acute, serious respir-

atory illness with fever, cough, shortness of

breath and breathing difficulties. Most pa-

tients have had pneumonia. Many have also

had gastrointestinal symptoms, including di-

arrhoea. Some patients have had kidney fail-

ure.

In people with immune deficiencies, the dis-

ease may have an atypical presentation. It is

important to note that the current understand-

ing of illness caused by this infection is based

on a limited number of cases and may change

as we learn more about the virus.

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What do you should know about MERS-CoV???

How widespread is Respiratory Syndrome Coronavirus (MERS-CoV)?

How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely

monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or

pneumonia. WHO will continue to share information as it becomes available.

How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the

source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pat-

tern and course of disease.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people

occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure.

More investigations are needed to look at the recent exposures and activities of infected humans. WHO is

working with partner agencies with expertise in animal health and food safety, including FAO, OIE and na-

tional authorities, to facilitate these investigations. Many technical organizations are offering their expertise to

assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols

and guidelines for dealing with new cases are available on the WHO website.

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How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs

through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investi-

gations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner

agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate

these investigations. Many technical organizations are offering their expertise to assist ministries responsible for hu-

man health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases

are available on the WHO website.

Should people avoid contact with animals or animal products?

Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice

on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided and basic hy-

giene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling

animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or

undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms

that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are

safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other

hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.

Are bats the source of the virus?

MERS-CoV has recently been found to be genetically related to a virus identified in bats from Southern Africa. But

there is no definitive evidence that MERS-CoV originates in bats.

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Can the MERS-CoV persist in the environment?

We do not yet know the answer to this question. Some types of environment are better suited for persistence of

certain viruses but we still do not know exactly how well and under what conditions MERS-CoV may persist in

the environment.

Is there a vaccine or treatment for MERS-CoV?

No. No vaccine is currently available. Treatment is largely supportive and should be based on the patient’s clini-

cal condition.

Are health workers at risk from MERS-CoV?

Yes. Transmission has occurred in health-care facilities, including spread from patients to health-care providers.

WHO recommends that health-care workers consistently apply appropriate infection prevention and control

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred.

These clusters have been observed in health-care facilities, among family members and between co-

workers. However, the mechanism by which transmission occurred in all of these cases, whether respira-

tory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environ-

ment by the patient, is unknown. Thus far, no sustained community transmission has been observed.

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A patient under investigation (PUI) is a person with the following characteristics:

fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence);

AND EITHER

history of travel from countries in or near the Arabian Peninsula1 within 14 days before symptom onset;OR

close contact2 with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia)

within 14 days after traveling from countries in or near the Arabian Peninsula;OR

is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization)

of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.

Clusters of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization)

should be evaluated for common respiratory pathogens. If the illnesses remain unexplained, providers should

consider testing for MERS-CoV, in consultation with state and local health departments.

Healthcare professionals should immediately report to their state or local health department any person being

evaluated for MERS-CoV infection as a patient under investigation (PUI). Health departments should immedi-

ately report PUIs to CDC using the MERS PUI short form provided in CDC website.

Health departments should send completed investigation short forms by FAX to CDC at 770-488-7107 or attach

the short form to an e-mail to eocreport@cdc.gov (subject line: MERS Patient Form).

To date, little is known about the pathogenic potential and transmission dynamics of MERS-CoV. To increase

the likelihood of detecting MERS-CoV infection, CDC recommends collecting multiple specimens from differ-

ent sites at different times after symptom onset.

Many state health department laboratories are approved for MERS-CoV testing using CDC’s rRT-PCR assay.

Appropriate infection-control measures should be used while managing patients who are PUIs or who have probable or

confirmed MERS-CoV infections

Healthcare professionals should carefully monitor for the appearance of fever and respiratory symptoms in any person

who has had close contact2 with a confirmed case, probable case, or a PUI while the person was ill.

If fever and respiratory symptoms develop within the first 14 days following the contact, the individual should be evalu-

ated for MERS-CoV infection.

Who Should Be Evaluated?

Clusters of Respiratory Illness in Which MERS-CoV Infection Should Be Considered

Reporting Patients Under Investigation (PUIs)

Laboratory Testing

Infection Control

Management of Contacts

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People who are being evaluated for MERS-CoV infection and do

not require hospitalization for medical reasons may be cared for

and isolated in their home. Isolation is defined as the separation

or restriction of activities of an ill person with a contagious dis-

ease from those who are well.

Before the infected Person

is Isolated at Home...you

must:

Assess whether the home

is suitable and

appropriate for isolating

the ill person.

The house should have

a functioning bathroom

that only the ill person

and household mem-

bers use.

The ill person

should have his or

her own bed and

preferably a private

room for sleeping.

Basic amenities, such as heat,

electricity, potable and hot

water, sewer, and telephone

access, should be available

If the home is in a multiple-

family dwelling, such as an

apartment building, the area in

which the ill person will stay

should use a separate air-

ventilation system, if one is pre-

sent.

There should be a primary

caregiver who can follow

the healthcare provider’s

instructions for medica-

tions and care.

Interim Home Care and Isolation Guidance for MERS-CoV

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Separate yourself from other people

in your home

As much as possible, you should stay in a different room from other people in your home. Also, you

should use a separate bathroom, if available.

Call ahead before visiting your doctor

Before your medical appointment, call the healthcare provider and tell him or her that you may have

Wear a facemask

You should wear a facemask when you are in the same room with other people and when you visit a

healthcare provider.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into

your sleeve.

Wash your hands

Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sani-

tizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your

eyes, nose, and mouth with unwashed hands.

Avoid sharing household items

You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items

with other people in your home. After using these items, you should wash them thoroughly with soap

and warm water.

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Place all used gloves, gowns,

facemasks, and other contam-

inated items in a lined con-

tainer before disposing them

Prevention Steps

for Caregivers

and Household

Members Help the ill person

follow the healthcare

provider's instruc-

tions for medication

Have only people in

the home who are es-

sential for providing

care for the ill person.

Other household

members should

stay in another

home or place of

residence.

Restrict visitors who do

not have an essential

need to be in the home.

Keep elderly people and

those who have compro-

mised immune systems or

specific health conditions

The home have

good air flow

Wear a disposable facemask,

gown, and gloves when you

touch or have contact with the

ill person’s blood, body fluids

and/or secretions.

Avoid sharing

household items.

Wash your hands often and

thoroughly with soap and wa-

ter

Clean all “high-touch” sur-

faces, such as counters, tab-

letops, doorknobs, bath-

room fixtures, toilets, and

Wash laundry

thoroughly.

Wear disposable gloves while

handling soiled items.

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Spreads:

By close contact

By air

Sites of known cases

Mecca, Saudi Arabia

(origin of MERS):

Site of annual Hajj and Umrah

Overcrowding sets perfect condi-

tions for the spread of MERS

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Saudi Government Initiatives

Visas

down

by 20%

per

country

Health

workers

up by

3,000 to

22,000

total

Elderly, children, pregnant

women and those with chronic

medical illness were discour-

aged from participating in Hajj.

Saudi Arabia, Ministry of Health Guidelines

Wear facemasks

Wash hand thoroughly after sneezing or coughing

Use disposable tissues

Avoid direct contact with infected person

Avoid touching eyes, nose or mouth

Pilgrims returning from Hajj are advised to seek medical

attention if they developed MERS like symptoms within

14 days after their trip.

Hajj 2013:

Number of pilgrims dropped by

approximately 1 million due to

MERS.

No outbreak of MERS &

only a handful of cases

reported.

International

pilgrims

down by

21%

Local

pigrims

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News on MERS– COv

Most MERS cases going undetected, 'slow epi-

demic underway': study November 12, 2013. A new analysis of MERS case data sug-

gests a large number of infections are going undetected, with

the researchers estimating that for each case that has been

found, five to 10 may have been missed.

THESTAR.COM

June 20, 2013. A mysterious new respiratory virus that originated in the Middle East spreads easily be-

tween people and appears more deadly than SARS. A patient who was receiving dialysis treatment spread MERS to seven others, including fellow dialysis pa-

tients at the same hospital. During SARS, such patients were known as “superspreaders” and effectively

s e e d e d o u t b r e a k s i n n u m e r o u s c o u n t r i e s .

But MERS appears far more lethal. Compared to SARS’ 8 percent death rate, the fatality rate for MERS

in the Saudi outbreak was about 65 percent, though the experts could be missing mild cases that

might skew the figures.

New Straits Times

MERS virus has infected camels since 1992

February 26, 2014. Scientists say the mysterious MERS virus has been infecting camels

in Saudi Arabia for at least two decades and early human cases probably went undiagnosed.

Since the Middle East respiratory syndrome coronavirus was first identified in 2012, doctors

have struggled to explain how many patients have fallen sick. MERS can cause symptoms

including fever, breathing problems and kidney failure. To date, it has infected more than

180 people and killed 79, mostly in the Middle East, though infections have also spread

to Europe and northern Africa.

New MERS virus spreads easily, deadlier than

SARS

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February 25, 2014. In a startling revelation,

researchers have found the deadly coronavirus

responsible for Middle East Respiratory Syn-

drome (MERS) - among camels.

MERS, a serious viral respiratory illness, has

been identified in 182 people since 2012,

according to the World Health Organisation

(WHO). Nearly 79 people have died from the

condition. Efforts to identify an animal source

of infection have focused on bats and camels

as the first known case of MERS was in a Saudi

Arabian man who had four pet camels.

In a study, investigators from the US and Saudi

Arabia conducted a comprehensive survey of

camels throughout Saudi Arabia. They collected

blood samples and rectal and nasal swabs from

camels, sheep and goats in November and De-

cember of 2013.Overall, 74 percent of camels sampled countrywide had antibodies to MERS-CoV.

More than 80 percent of adult camels throughout the country had antibodies to the virus.

The researchers also found that active virus was frequently detected in nasal swabs in 35 percent of

young camels and 15 percent of adult camels countrywide.

It was less frequently found in rectal swabs and not in blood, indicating that the virus most likely is

spread by respiratory secretions.

Malaysia Sun

CAMELS carry deadly virus

TH medical team ready for MERS threat

MAKKAH: The Pilgrims Fund Board (Tabung Haji) health and medical teams here and in Medina are ready to face the Novel corona virus or Middle East Respiratory Syndrome Corona virus (MERS-CoV) pandemic.

September 27, 2013. Malaysian Haj Delegation (Medical) deputy

head Dr Mohamad Faid Abdul Rashid said the Tabung Haji teams

were well-equipped to handle the situation, in the event of an epi-

demic.

New Straits Times

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Tips for those visiting

Middle East countries

June 8, 2013. Health Ministry director-general Datuk Dr Noor Hisham Abdullah said the dis-

ease had spread in a few countries in the Middle East and Europe. However, the World

Health Organisation had not issued any travel advisory against going to the affected coun-

tries.

"The ministry has outlined several precautionary measures to those who wish to visit the af-

fected countries, especially those who will be travelling there to perform their haj or umrah."

Visitors were advised to wash their hands frequently with soap and water or hand sanitisers

especially after coughing, sneezing or shaking hands."Always carry a mask and hand sanitis-

ers, and avoid eating uncooked or raw food. Make sure fruits are washed before they are eat-

en and drink only treated water."

He said the ministry had not detected the presence of the virus in Malaysia.

"Passengers arriving at the Kuala Lumpur International Airport's arrival hall will undergo a

special screening process."Any cases of respiratory-related illness in the country are also

closely monitored." Dr Noor Hisham added that the ministry had upgraded facilities in hospi-

tals to accommodate patients in the event the virus had been detected.

"The ministry will work closely with Lembaga Tabung Haji to monitor the health of pilgrims

before, during and after their visit."The pilgrims will be briefed about MERS-CoV and the

precautionary measures they will have to take."

MERS-CoV is caused by the coronaviruses. The most common symptoms observed are fe-

ver, cough, shortness of breath and breathing difficulties while atypical symptoms, such as

diarrhoea, have also been seen in patients with immunosuppression.

New Straits Times