Given the current outbreak of Middle East Respiratory Syndrome in South Korea, we take a closer look at MERS, how it spreads and the risk it poses to us in Australia.
[Image source: AFP: Yonhap]
The Middle East Respiratory Syndrome (MERS) has been around since September 2012, but only recently made the news here in Australia. There are many concerns and unknowns about MERS such as: What is the risk of an outbreak in Australia? Could we be facing another pandemic like swine flu? What can we do to prevent the illness spreading?
So what do we really need to worry about?
The risk to Australia
Associate Professor Sanjaya Senanayake, an infectious disease physician from the Australian National University, says we are not currently facing a pandemic.
“However the risk to Australia is the same as it was during the Ebola outbreak from a traveller bringing the infection into the country,” he says.
“What has brought it to light in Australia is its introduction into the Asia Pacific region, with the recent outbreak in Korea the biggest outbreak so far outside the Middle East.”
Since MERS was first described in 2013, nobody in Australia has been confirmed as having the disease, however it’s possible if an infected traveller was to arrive in Australia. All people who have developed MERS have lived in or travelled to the Middle East (mostly Saudi Arabia) or had some contact with travellers returning from the Middle East.
“A lot of Australians fly to Europe through the Middle East, presumably many more than those who travel here from West Africa,” Senanayake says.
This may increase the risk of a returning traveller bringing the virus into the country. “Even Ebola was only a plane ride away,” he says.
Compared to the spread throughout the Middle East, the outbreak in Korea has been fairly rapid with a relatively large number of cases in a short amount of time. This has led to concerns that the virus has mutated and become more transmissible, Senanayake says.
“Testing shows the virus in Korea is genetically very similar to the virus in the Middle East,” he says. “That hasn’t happened yet, but there is ongoing concern that the illness is not disappearing like SARS did. There is concern that the virus will mutate and become more transmissible.”
Another explanation for the rapid spread in Korea could be the presence of a “super-spreader”, Senanayake says.
“Super-spreaders are people with an uncanny ability to spread the virus to a lot more people than most people can. We saw super-spreaders during the SARS outbreak of 2003.
“However there is no need to panic,” Senanayake says. Since the Ebola outbreak, hospitals and health services are much more prepared to deal with outbreaks of other infections. “During the Ebola outbreak we saw the mortality drop from 90 per cent to about half that. The awareness, training and practices will apply to other infections.
“Hospitals are better equipped to recognise [that] you might have the infection, reduce the exposure to other people and start appropriate treatment.”
How does MERS differ from other respiratory illnesses?
MERS usually starts with symptoms such as fever and chills, sore throat, aches and pains, cough and shortness of breath. Gastrointestinal symptoms are also common. Some people don’t get any symptoms at all.
“MERS is a very non-specific illness at the start,” Senanayake says. “It could be caused by any respiratory tract infection or flu-like illness. Even Ebola can start off like that.”
Because it’s hard to tell if you have MERS just from symptoms, if you have a fever and have recently been travelling in the Middle East, or come into contact with someone who has recently returned from the Middle East, don’t hesitate to go to your doctor, Senanayake advises.
How contagious is MERS?
It is not yet known how contagious MERS is or all the ways it can spread between people.
But whilst the death rate is higher in MERS than in SARS, or various strains of flu, it appears to be less infectious, Senanayake says.
It is believed people catch the illness from contact with camels or camel products, including raw camel milk, camel urine or camel meat that has not been properly cooked. Bats can also carry the MERS virus.
The disease can spread from person to person, but it is not yet known if this is from touching contaminated surfaces, inhaling infected droplets from coughing or sneezing, or catching the disease in another way. The virus can be found in respiratory secretions for up to two weeks.
Most person-to-person spread of the disease has occurred in healthcare facilities. “In hospitals, people are very sick and they may undergo procedures that help release the virus into the surroundings e.g. with a nebuliser,” Senanayake says.
Many healthcare workers have developed the illness, but there have been no reports of it spreading in the community.
“MERS appears to be less infectious in community settings, but we don’t understand everything about how it is transmitted.”
How deadly is MERS?
So far it seems MERS is fatal in just over a third of people who have had the illness.
To date more than 1,270 people have been confirmed to have MERS worldwide, and of these at least 450 people have died.
People who are elderly, have a weakened immune system or who have other underlying health conditions such as cancer, chronic lung disease and diabetes have a higher risk of MERS developing into severe pneumonia with acute respiratory distress syndrome and organ failure requiring treatment in intensive care and possible death from the illness.
How is it prevented?
Senanayake says the best prevention is to: “avoid these parts of the world, which may be impossible for certain people”.
Precautions you should take if you are travelling to the Middle East include:
- avoiding direct contact with camels, camel urine, raw camel milk or uncooked camel meat;
- avoiding contact with sick animals;
- washing your hands regularly, especially after touching animals and if you visit places like farms, markets and barns where there are camels or other animals;
- minimising contact with people who are sick or have a cough;
- ensuring food is well cooked particularly camel products;
- practicing cough etiquette cover your nose and mouth with a tissue when you cough or sneeze, or cough or sneeze into the crook of your elbow NOT into your hands;
- going to the doctor if you develop a severe respiratory illness while you are travelling or within two weeks of your return to Australia.
How is it treated?
Senanayake says to date there is no known specific antiviral treatment for MERS other than to support the ill person with fluids, oxygen and ventilation. “Animal studies show an antiviral agent called ribavirin together with interferon may work, but it’s not know if this will work in people,” he says.
There is also no vaccine to protect against the virus or prophylaxis available for people who have been in contact with someone who has the illness.
So far MERS has been controlled by public health measures, such as promoting good hygiene practices like hand washing, trying to pick up cases early and keeping people isolated while they are sick so they can’t transmit the infection to others.
What we know
Middle East Respiratory Syndrome (MERS) is caused by a coronavirus (MERS-CoV) which is similar to the virus that causes the common cold as well as SARS (Severe Acute Respiratory Syndrome).
- The syndrome was first described in September 2012;
- More than 1,270 confirmed cases have been reported in at least 25 countries world wide;
- More than 85 per cent of cases have been reported in Saudi Arabia. There has been a recent outbreak in Korea affecting at least 165 people and recently a case reported in Thailand. Countries affected include:
- Middle East: Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, the United Arab Emirates, Yemen
- Europe: Austria, France, Germany, Greece, Italy, Netherlands, Turkey, United Kingdom (UK)
- Africa: Algeria, Tunisia, Egypt
- Asia: China, Korea, Malaysia, Thailand, the Philippines
- The USA
- Everyone who has caught the illness lives in or has travelled to the Middle East including Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman, Jordan, Kuwait, Lebanon and Yemen;
- To date at least 450 people have died and those most at risk of dying were older or had pre-existing health conditions;
- The incubation period is two to 14 days; most commonly five days;
- Good hygiene is essential to help prevent the spread of the illness because as yet, there is no known specific antiviral treatment, immunisation or prophylaxis available.
What we don’t know:
- How contagious the illness is;
- How it spreads from animals to people or from person-to-person;
- How long people are infectious once they have caught the illness.