South Korea reported a 10th death from a MERS outbreak on Thursday, although officials say they believe the disease has peaked. The victim was a 65-year-old man who had been treated for lung cancer and was hospitalized in the same facility as another MERS patient, the Health Ministry said. The outbreak of Middle East respiratory syndrome has caused panic in South Korea. It has infected more than 120 people since the first case, a 68-year-old man who had traveled to the Middle East, was diagnosed on May 20.
About 3,800 people remained isolated Thursday after possible contact with infected people, according to the ministry. More than 2,600 schools and kindergartens across South Korea were closed.
What is MERS?
Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus(http://www.cdc.gov/coronavirus/index.html)) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS affects the respiratory system (lungs and breathing tubes). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died.
Health officials first reported the disease in Saudi Arabia in September 2012. Through retrospective investigations, health officials later identified that the first known cases of MERS occurred in Jordan in April 2012. So far, all cases of MERS have been linked to countries in and near the Arabian Peninsula.
MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person. MERS can affect anyone. MERS patients have ranged in age from younger than 1 to 99 years old. CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. CDC recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. We have provided information for travelers and are working with health departments, hospitals, and other partners to prepare for this.
What are the symptoms?
Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with symptoms of:
- fever
- cough
- shortness of breath
Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. About 3-4 out of every 10 people reported with MERS have died. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered.
Based on what researchers know so far, people with pre-existing medical conditions (also called comorbidities) may be more likely to become infected with MERS-CoV, or have a severe case. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case.
Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.
Who is at Risk?
Recent Travelers from the Arabian Peninsula If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula*, you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.
Close Contacts of an Ill Traveler from the Arabian Peninsula If you have had close contact** with someone within 14 days after they traveled from a country in or near the Arabian Peninsula*, and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.
If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.
People recently in a healthcare facility in the Republic of Korea If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea, you should call ahead to a healthcare provider and mention your recent presence in the healthcare facility. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.
Close Contacts of a Confirmed Case of MERS
If you have had close contact** with someone who has a confirmed MERS-CoV infection, you should contact a healthcare provider for an evaluation. Your healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of your evaluation and whether you have symptoms. You most likely will be asked to monitor your health for 14 days, starting from the day you were last exposed to the ill person. Watch for these symptoms:
- Fever. Take your temperature twice a day.
- Coughing
- Shortness of breath
- Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.
If you develop symptoms, call ahead to your healthcare provider as soon as possible and tell him or her about your possible exposure to MERS-CoV so the office can take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.
Healthcare Personnel Not Using Recommended Infection-Control Precautions
Healthcare personnel should adhere to recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. Recommended infection control precautions should also be utilized when collecting specimens.
Healthcare personnel who had close contact** with a confirmed case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by a healthcare professional with a higher index of suspicion.
For more information, see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)(http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html).
People with Exposure to Camels
MERS-CoV has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with MERS-CoV—many people with MERS have had close contact with a person sick with MERS.
The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products. For more information, see WHO’s Frequently Asked Questions on MERS-CoV. (Should people avoid contact with camels or camel products? Is it safe to visit farms, markets, or camel fairs?)
The World Health Organization considers certain groups to be at high risk for severe MERS; these groups include people with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems. The World Health Organization recommends that these groups take additional precautions:
- Avoid contact with camels
- Do not drink raw camel milk or raw camel urine
- Do not eat undercooked meat, particularly camel meat
For more information, see WHO’s MERS-CoV Summary and Literature Update, June 11, 2014 [8 pages]. (See page 8 for recommendations.)
*Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.
**Close contact is defined as a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations); or b) having direct contact with infectious secretions (e.g.,being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations). Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact.
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