Updates on MERS and Cylospora

Updates on MERS and Cylospora

According to the Center for Infectious Disease Research and Policy (CIDRAP),
http://www.cidrap.umn.edu/news-perspective/2013/07/who-issues-mers-travel-advice- new-case-reported

“The World Health Organization (WHO) advised that people who have chronic medical conditions and want to go on a pilgrimage to Saudi Arabia, epicenter of MERS-CoV (Middle East respiratory syndrome coronavirus), should talk with their healthcare provider about the risks.”

Saying the risk to travelers is “very low,” the WHO recommended no travel restrictions or border screening during the Muslim Umrah and Hajj pilgrimages, which are expected to draw millions of people to Saudi Arabia. The recommendations focus on awareness and routine precautions to prevent travel-related infections.

Meanwhile, Saudi Arabia has reported another MERS case and the death of a previously reported case-patient, according to a translated government statement posted on FluTrackers, an infectious disease message board.

Pilgrims flock to Saudi Arabia for Umrah during the Muslim holy month of Ramadan (Jul 9 to Aug 7 this year), and far more travel there for the Hajj, which this year falls in October (Oct 13 to 18).

Today’s WHO statement fulfills a promise made last week, when the agency announced that its special emergency committee on MERS-CoV concluded that the disease did not yet constitute an international public health emergency. The WHO guidance, framed as advice for governments of countries from which pilgrims will be coming, does not go as far as the Saudi advisory.

“At this time, the risk to an individual pilgrim of contracting MERS-CoV is considered very low,” the WHO said in a statement e-mailed to reporters.

The guidance recommends caution, however, for those with chronic health problems: “Countries should advise pilgrims that pre-existing major medical conditions (e.g., chronic diseases such as diabetes, chronic lung disease, immunodeficiency) can increase the likelihood of illness, including MERS-CoV infection, during travel; thus, pilgrims should consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is advisable.”

The WHO also says that governments should provide departing pilgrims and travel organizations with guidance on general travel precautions, including hand washing, food safety, personal hygiene, and avoiding unnecessary contact with animals. Health advisories should be placed at key locations such as travel agent offices and airports, the agency says.

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Among other recommendations, the WHO also advises that:

  • Healthcare practitioners and facilities should be provided with WHO guidelines (or their national equivalents) on infection control and clinical management for MERS-CoV
  • Medical personnel accompanying pilgrims should be up to date on MERS- CoV information and guidance
  • Returning pilgrims should seek medical attention if they experience a respiratory illness with fever and cough within 2 weeks after returning home
  • Persons who experience a significant respiratory illness after having contact with a returning traveler with such an illness should report to local health authorities so they can be monitored for MERS-CoV
  • Countries should make sure routine measures are in place for assessing sick travelers on airplanes and ships and at ports of entry

EMS agencies that serve areas where there are Arabic populations should be familiar with the WHO recommendations and be cognizant of the dates for pilgrimage to Saudi Arabia.

Patients with unexplained respiratory illnesses should be questioned about travel to the Middle East and normal personal protective techniques should be used.

Cyclospora outbreak Investigations

The Centers for Disease Control and Prevention has issued an update on their investigation into the Cyclospora outbreak: http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013.html

“As of July 26, 2013, CDC has been notified of 353 cases of Cyclospora infection from the following 15 health departments: Iowa , Texas , Nebraska , Florida, Wisconsin , Illinois, New York City, Georgia, Missouri, Arkansas, Connecticut, Kansas, Minnesota, New Jersey, and Ohio.

Most of the illness onset dates have ranged from mid-June through early July. At least 21 persons reportedly have been hospitalized in three states.

No food items have been implicated to date, but public health authorities are pursuing all leads. Previous outbreak investigations have implicated various types of fresh produce.

It is not yet clear whether the cases from all of the states are part of the same outbreak. Additional cases are currently under investigation and will be included on this page as states confirm them. Cases in this outbreak are defined as laboratory-confirmed Cyclospora infection in a person who became ill in June or July, 2013, and had no history of travel outside of the United States or Canada during the 14 days prior to onset of illness.”

Disease
Among symptomatic persons, the incubation period averages ~1 week (ranges from ~2- 14 or more days). Cyclospora infects the small intestine and typically causes watery diarrhea, with frequent, sometimes explosive, stools. Other common symptoms include loss of appetite, weight loss, abdominal cramping/bloating, increased flatus, nausea, and prolonged fatigue. Vomiting, body aches, low-grade fever, and other flu-like symptoms may be noted. If untreated, the illness may last for a few days to a month or longer, and may follow a remitting-relapsing course.

Recommendations
EMS agencies should consider patients with complaints consistent with Cyclospora infection, mainly gastrointestinal complaints as possibly infected. Using universal precautions including frequent hand washing as well as keeping equipment clean will protect the provider and patients.

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