WHO raises MERS concerns, holds off on declaring emergency

The sharp rise in Middle East respiratory syndrome coronavirus (MERS-CoV) cases and the impact of the disease are concerning, but it doesn't meet the definition of a public health emergency of international concern (PHEIC), the World Health Organization (WHO) announced today, following its emergency committee's deliberations yesterday.

Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, said at a media telebriefing today that after the committee heard from outside experts and health officials in affected countries and learned the findings of a WHO group that traveled to Saudi Arabia, it saw no evidence of sustained transmission in the community.

Increased seriousness, urgency

"The consensus was that the situation has increased in seriousness and urgency, but did not constitute a public health emergency of international concern," he said. In weighing the sharp increase in cases since March, especially in Saudi Arabia and the United Arab Emirates, the group learned that suboptimal infection control practices, made worse by severe overcrowding in emergency departments, have led to a number of secondary infections in hospitals.

The reasons for an increase in cases outside of hospitals are less clear and might reflect seasonal factors, better surveillance, or an increased ability of the virus to spread among people, Fukuda said.

"This is quite a pressing question," he said. However, he noted that there are still very few secondary infections in case contacts, no evidence of community spread, no sustained transmission when cases are detected in other countries, and no major genetic changes in the virus that might affect its transmissibility.

Fukuda said MERS viruses sequenced from recent cases in Saudi Arabia, the United States, and Greece look very much like earlier viruses. "Right now we don't see major changes, but a caveat is that sometimes minor changes can lead to changes in properties, such as transmission," he said.

The same basic infection control measures should be applied with all patients, because, while MERS is a respiratory illness, not all patients display all symptoms, and some have diarrhea, he said. He added that health officials don't have a good handle on the route of transmission in hospitals, though the general behavior of the virus seems consistent with droplet spread.

Better infection control needed

The committee recommended several steps for countries to take, with the most urgent one being stronger infection control practices, especially in countries where the disease is active. Fukuda said simple things like washing hands between patients, wearing gloves at the right time, and changing gloves and masks between patients can go a long way toward containing the virus.

The emergency committee also strongly urged countries to:

  • start and speed up investigations to pinpoint risk factors and flesh out the epidemiology, which includes case-control, serological, environmental, and animal studies
  • support vulnerable countries, especially those in sub-Saharan Africa
  • strengthen case and contact identification and management
  • boost awareness and risk communication about the disease among all groups
  • collaborate and share information with other health ministries and global organizations, especially animal health agencies
  • develop advice for people who will be attending mass gatherings, such as Umrah or the Hajj
  • share information with the WHO in a timely manner, as specified in the International Health Regulations (IHR)

The WHO said in a statement today that the emergency committee will meet again in June to assess the latest developments and will meet earlier if needed.

Yesterday was the committee's fifth meeting to discuss MERS-CoV developments and gauge whether the situation meets the WHO's definition of a public health emergency of international concern. The last time it met was in December, before the surge of case in Saudi Arabia that started at the end of March and is spawning more exported cases in other countries. Since then, more studies have strengthened the suggestion that camels are the main reservoir for the virus.

WHO emergency committees are part of the IHR, passed by the World Health Assembly in 2005 in the wake of the SARS (severe acute respiratory syndrome) outbreak. Emergency committees have made PHEIC designations twice before: when the 2009 H1N1 virus started sweeping the globe and just last week for polio.

See also:

May 14 WHO statement

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