Florida health workers have symptoms after MERS patient contact

Empty hospital room
Empty hospital room

hxdbzxy / iStockphoto

Florida health officials are monitoring two health workers who came down with flulike symptoms after unprotected contact with the second imported US Middle East respiratory syndrome coronavirus (MERS-CoV) patient when he first sought care.

In addition, amid a flurry of activity with the US infections and cases still rising in Saudi Arabia, with four more reported today, the World Health Organization (WHO) emergency committee on MERS met. The group will announce tomorrow if the latest developments warrant a public health emergency of international concern.

At a media telebriefing at the Orlando hospital where the MERS patient and one of the health workers are being treated in isolation, health officials also said they are monitoring roughly 100 local people who may have been exposed to the virus. Those being monitored include employees at another Orlando hospital the patient visited while accompanying someone who underwent a medical procedure.

Though MERS-CoV does not appear to pass easily from person to person in the community, the risk of transmission is much greater in close contact situations, such as when family members or healthcare workers are caring for sick patients. Also, experts have said hospital transmission is magnifying a surge in infections in Saudi Arabia, with mystery still swirling around how the virus is spreading in the facilities.

Both of the imported US cases are in health workers who live in Saudi Arabia and are employed by hospitals, one in Jeddah and the other in Riyadh.

Details on symptomatic health workers

Antonio Crespo, MD, infectious disease specialist at Dr. Phillips Hospital in Orlando, said one of the healthcare workers developed symptoms 24 hours after exposure to the MERS patient, which is shorter than the 2- to 14-day incubation period for the disease. The second healthcare worker got sick 72 hours after exposure.

One of the workers has an underlying condition and is in voluntary home isolation, and the other was admitted to one of the hospital's isolation units.

Both of the professionals had unprotected contacted with the patient before MERS infection was suspected. The US Centers for Disease Control and Prevention (CDC) recommends that healthcare workers caring for MERS patients wear gowns, gloves, eye protection, and an N95 respirator.

Federal and state health officials who announced the case yesterday said the man is a 44-year-old health worker who lives and works at a hospital in Jeddah that has treated MERS patients. The man was symptomatic when he flew to the United States on May 1, and did not have a cough, even when he was first seen at the Orlando hospital where he is being treated.

Tests are under way on samples from the two health workers, with results due back as soon as tomorrow.

Health officials have said the MERS patient had limited activity in the Orlando area between the time he arrived and sought care at Phillips Hospital. He didn't visit any of the tourist attractions. On May 5, however, he was at Orlando Regional Medical Center with someone else, but did not seek care, despite having fever, chills, and muscle aches.

Follow-up of other contacts

US health officials are taking extra precautions to prevent healthcare-related MERS infections, including home isolation and monitoring for health workers who may have had unprotected contact. Florida health officials said today that 20 healthcare workers, including four physicians, between the two hospitals the patient visited are being monitored for the 14-day incubation period.

Meanwhile, 50 health workers from the Munster, Ind., hospital where the first US MERS patient was treated have returned to their jobs, according to a report today from WLS TV, the ABC affiliate in Chicago. Alan Kumar, MD, the chief medical information officer at Community Hospital in Munster, said the 35 employees who were in contact with the man returned to work on May 11, and 15 of them passed the incubation period yesterday.

As a precaution, Florida health officials are contacting dozens of people who may have shared a waiting room with the patient, and several states are contacting US passengers who shared flights the patient took while traveling from Jeddah to Orlando.

Saudi Arabia reports 4 cases, 5 deaths

Meanwhile, Saudi Arabia's health ministry today reported four new MERS cases, one of them fatal, along with four deaths in previously confirmed patients.

All four of the new cases are from Riyadh, one of the main outbreak hot spots. They range in age from 20 to 69 years. Three of the patients are women, and three are in stable condition.

The patient who died is a 69-year-old man with underlying health conditions who was hospitalized for heart disease on Apr 28 and got sick with respiratory symptoms on May 11. He died yesterday after he was admitted to an intensive care unit.

All four patients first had symptoms on May 11. Two of the patients had contact with a confirmed case and are in home isolation. The 20-year-old woman appears to have been exposed to the virus in the hospital after she was admitted for a heart problem on May 9.

Among the four deaths in previously confirmed case, all patients died yesterday and are from Jeddah. Their ages range from 29 to 60 years, and three were men.

The new cases and deaths boost Saudi Arabia's number of MERS infections to 495 and the number of deaths to 152.

WHO emergency committee decision awaited

In other news, the WHO's emergency committee on MERS met today to consider recent developments, its first meeting since a surge of cases, mostly from Saudi Arabia, began in late March. Today's meeting was the fifth to discuss the outbreak and to deliberate whether the events qualify as a "Public Health Emergency of International Concern."

The group was expected to announce its findings today, but the meeting lasted longer than expected, and the WHO told journalists that it will share the details at a media telebriefing tomorrow at 1:00 pm Geneva time.

The WHO established the committee last July, based on International Health Regulations. It met four times last year, most recently on Dec 4. Since then, the Middle East has seen a burst of cases, mostly in Saudi Arabia, but also in the United Arab Emirates.

A WHO expert group that recently traveled to Saudi Arabia said hospital transmission appears to be amplifying what may be a seasonal increase in cases. Also, a handful of recent studies have found stronger evidence that camels are probably one of the major sources of the virus.

Qatar camel virus can infect humans

One such camel study was published yesterday. Nasal swabs taken from camels in Doha, Qatar, in February yielded the MERS virus that was nearly identical to a human isolate, and the virus isolated from a sample was able to replicate in human cells.

A team from Erasmus University in the Netherlands and Qatar reported the findings in Emerging Infectious Diseases. They obtained samples from 53 healthy dromedary camels, finding the virus in only 1 of them, an 8-month-old animal.

When they compared genetic sequences of the virus with other MERS viruses, they found that its closest match was to a virus from a patient diagnosed in England who got sick in Qatar a year earlier. The team wrote, though, that there's no indication the patient had been exposed to the camel population that they sampled.

The findings provide more evidence that dromedary camels are a reservoir for the MERS virus and can transmit the disease to humans, they concluded. They added, however, that more studies are needed to pinpoint whether contact with camels or camel products pose the biggest risk of infection.

OIE on zoonotic routes

The study is one of several recent reports that have fleshed out more information about camels' antibodies to the virus and their role as the possible source of the virus, and the World Organization for Animal Health (OIE) yesterday weighed in on the latest findings.

t said that although recent studies hint that camels may be the source of some human cases, further work is needed to spell out the exact relationship between MERS infection in humans and animals.

It's possible that there are several transmission routes within and between species and that other potential sources should be studied, including other humans, camels (including raw products), other wild and domestic animals, as well as the environment, food, and water, the OIE said.

See also:

May 12 Orlando Health press release

May 13 WLS news story

May 13 Saudi MOH statement

Saudi MOH MERS page with case count

May 12 Emerg Infect Dis study

May 12 OIE MERS-CoV Q and A update

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