In 2012, a new virus suddenly appeared in the Middle East. It resembled the Severe Acute Respiratory Syndrome virus that caused the first pandemic of this millennium.
The new virus also caused severe respiratory infections. Because of its emergence and initial localisation in the Middle East, the disease was named Middle East Respiratory Syndrome corona virus — Mers CoV.
The origin of the virus remains unknown. The current epidemiological picture indicates camels and bats as possible sources. Human-to-human transmission has been occurring mostly in healthcare facilities in the Middle East where this disease has taken the form of a protracted emergency.
Mers has caused 1,342 human cases and 477 deaths in 26 countries – Thailand being the latest where the first case was detected on June 15. The patient, an elderly man from Oman, and 36 people in contact with him, have been cleared.
Most of the Mers cases have been reported from Saudi Arabia. Most recently South Korea experienced a wave of Mers cases subsequent to the arrival of a patient from the Middle East.
Vulnerable populations, especially those with two chronic diseases, are at a higher risk of contracting this infection and succumbing to it. They need to take extra caution if they reside in Mers endemic areas or wish to travel there.
In the absence of any vaccine or antiviral medicines, the control of this disease rests upon cutting short the transmission of the infection between humans. This warrants early diagnosis, rapid isolation of patients, detection of contacts through an efficient surveillance and community awareness.
For Mers CoV — as has been for Ebola virus disease, implementation of effective infection prevention and control measures hold the key to prevent and stop the disease.
Recommended facilities and appropriate application of infection prevention and control practices are essential prerequisites in combating such infections. Emphasis must be on maintaining skills of healthcare workers at all levels and awareness among communities.
Given the current pattern of transmission of this disease, WHO does not recommend travel or trade restrictions with regard to this event. It is, however, recommended that precautions aimed at raising awareness among travellers to and from affected countries may be undertaken.
Individuals who come back from affected countries must report to a health facility if they develop symptoms of acute respiratory illness with fever and cough within two weeks of their travel. At the same time, they must also minimise their contact with others to prevent infecting them.
While the Middle East has been the epicentre of this disease, contemporary rapid travel and globalisation puts every country at risk.
Disease spread accompanied with panic and fear has the potential to severely impact economies by hitting tourism and trade. Countries with weak health systems are usually the ones that are most affected.
In past four decades, almost 40 new disease-causing pathogens — mostly viruses — have been identified. The emergence of new viruses is a continuous process that cannot be stopped. Most of these originate from animals. Ecological alterations, growing populations, rapid urbanisation, climate change and weak health systems are a few of the several factors that influence the appearance and persistence of these pathogens.
Unless swiftly contained, the initial few cases can explode into an outbreak and spread to newer areas and populations. The best chance of controlling a new infectious disease is during the initial phase itself.
Preparedness and response to such outbreaks need to be strengthened and sustained on a permanent basis. Any breach can cause serious harm to health as well as to economies.
Strong health systems are the key to effectively respond to any case of importation. There is an urgent need for countries to ensure sustained investments to keep health systems alert and responsive to the evolving needs.
Continuous vigilance, strong preparedness and capacity to mount effective responses are critical in our collective endeavour in blunting and mitigating the impact of new and emerging pathogens, including Mers CoV.
Dr Poonam Khetrapal Singh is Regional Director, WHO South-East Asia Region.