Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a

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1 Middle East Respiratory Syndrome Coronavirus MERS 中东呼吸综合征

2 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died. The Symptoms of MERS Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with symptoms of fever, cough and shortness of breath. Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered. Based on what researchers know so far, people with pre-existing medical conditions (also called comorbidities) may be more likely to become infected with MERS-CoV, or have a severe case. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case. MERS can affect anyone. MERS patients have ranged in age from younger than 1 to 99 years old. Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days. MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person. However, there is no evidence of sustained spreading in community settings. Infected people have spread MERS-CoV to others in healthcare settings, such as hospitals. Researchers studying MERS have not seen any ongoing spreading of MERS-CoV in the community.

3 All reported cases have been linked to countries in and near the Arabian Peninsula. Most infected people either lived in the Arabian Peninsula or recently traveled from the Arabian Peninsula before they became ill. A few people became infected with MERS-CoV after having close contact with an infected person who had recently traveled from the Arabian Peninsula. Public health agencies continue to investigate clusters of cases in several countries to better understand how MERS-CoV spreads from person to person. Globally, WHO has been notified of 1149 laboratory-confirmed cases of infection with MERS-CoV, including a t least 431 related deaths. The latest information on cases can be found in WHO Disease Outbreak News at Prevention & Treatment Prevention Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. National Institutes of Health is exploring the possibility of developing one. Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash. Avoid touching your eyes, nose and mouth with unwashed hands. Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people. Clean and disinfect frequently touched surfaces such as toys and doorknobs. Treatment There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS can seek medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.

4 WHO Advice Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns. Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures. Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

5 IMH advice to individuals at this stage: 1. Maintain good personal hygiene precautions as listed in prevention session and avoid close contact with persons with respiratory symptoms and avoid staying in crowded places for long period; 2. Consider necessity of travelling to the Middle East or places with reported confirmed cases of MERS-CoV, especially for those with pre-existing major medical conditions; 3. Travellers returning from the affected areas who develop a significant acute respiratory illnesses with fever and cough should minimize there contact with others and seek medical attention immediately; IMH advice to Companies at this atage: 1. Communicate general information and precautions with employees and avoid panic 2. Review your corporate Pandemic Preparedness Plan with company healthcare provider 3. Review your travel restriction policy with alignment of business decisions 4. Encourage seasonal flu vaccination program 5. Conduct tabletop drills in all major facilities with practice of Business Continuity Plan 6. Check stockpile of PPEs and other materials according to response level of corporate PPPs Need more information on pandemic preparedness, please contact IMH medical operation support team at ann_wang@imhealthcare.cn

6 MERS 中东呼吸综合征中东呼吸综合征 (MERS) 是有一种新型冠状病毒 (MRES-CoV) 引起的病毒性呼吸道疾病,ERS 影响呼吸系统 ( 肺部和呼吸道 ) 大多数 MERS 患者出现严重急性呼吸系统疾病与发烧, 咳嗽和呼吸急促的症状每 10 名被报告的患者中有 3-4 人已经死亡中东呼吸综合征的症状典型病例常呈现发热咳嗽和气短等症状, 在检查中经常发现肺炎表现胃肠道症状, 如腹泻等也有报道重症病例可导致呼吸衰竭, 需要在重症监护室内机械通气和支持治疗部分病例可出现器官衰竭, 尤其是肾衰竭和感染性休克病死率大约为 27% 该病毒似乎会导致免疫力低下的人群, 老年人和伴有慢性病 ( 如糖尿病癌症和慢性肺部疾病 ) 的人群发生更严重的疾病感染中东呼吸综合征的症状和非典有些相似, 潜伏期在 2 14 天, 感染者会出现急性严重呼吸道疾病, 伴有发热咳嗽气短及呼吸困难, 严重的病例会出现肾功能衰竭患有糖尿病, 慢性肺部疾病, 肾衰, 或免疫力低下的人群被认为是患 MERS-CoV 的高风险人群目前, 中东呼吸综合征冠状病毒的传染源和传播途径尚不完全明确但有证据表明, 在与病例密切接触的家人和医护人员中可以发生有限的人传人, 病毒发生大规模暴发流行的可能性不大呼吸综合征病毒于 2012 年首次出现在沙特, 之后在中东等地传播, 欧洲非洲亚洲等 20 多个国家陆续出现疫情和医务人员感染中东呼吸综合征与 2003 年肆虐的非典同属冠状病毒, 其传染性不及非典, 但病死率比非典高目前最新报道显示 : 2015 年 5 月 27 日晚 10 时世界卫生组织通报 : 韩国一例确诊中东呼吸综合征 (MERS) 病例的密切接触者经香港入境广东省惠州市, 已出现发热症状及中东呼吸综合征的症状以下国家已经报告了中东呼吸综合征病例 : 中东地区的沙特阿拉伯阿联酋约旦科威特阿曼卡塔尔和也门 ; 非洲的埃及和突尼斯 ; 欧洲的法国德国荷兰希腊意大利和英国 ; 亚洲的韩国菲律宾马来西亚和黎巴嫩以及北美的美国全球目前已通报了 1149 例 MERS-CoV 确诊病例, 包括至少 431 例死亡病例关于病例的最新通报可以在世界卫生组织官网查询

7 中东呼吸综合征的治疗及预防对于中东呼吸综合征尚无特异性治疗措施和疫苗, 治疗方法主要是对症支持治疗因此, 做好预防是关键特别是赴中东国家 ( 包括沙特阿拉伯卡塔尔约旦克等 ) 或到近期有疫情发生国家 ( 如韩国 ) 旅游等应特别注意个人预防措施包括 : 常洗手, 用流动水和肥皂洗手至少 20 秒 ; 帮助小孩以同样标准洗手如果没有肥皂和水, 可使用含酒精的洗手液 ; 在打喷嚏时用纸巾掩住口鼻, 将纸巾纸巾丢弃至垃圾桶 ; 避免用未清洗的手接触眼睛鼻子和嘴 ; 避免和病人亲密接触, 如亲吻共用水杯或餐具 ; 经常清洗和消毒容易接触的表面如玩具门把手等世界卫生组织建议 WHO 正与临床医生和科学家收集和共享科学证据, 以更好地了解 MERS-CoV 及其所致的疾病 MERS, 并确定暴发应对重点治疗策略和临床管理方法 WHO 正与相关国家及国际伙伴协调全球卫生应对, 包括提供相关情况的最新信息, 开展风险评估, 与国家当局联合调查, 召开科学会议, 对卫生行政部门和卫生技术机构开发关于临时监测的指南并开展培训, 病例的实验室检测, 感染的预防和控制和临床管理总干事在国际卫生条例的框架下召开了一次紧急委员会, 来讨论此事件是否为构成国际关注的突发公共卫生事件及应采取的公共卫生措施紧急委员会将根据疫情形势需要再次召开 WHO 鼓励所有的成员国加强严重急性呼吸道感染 (SARI) 的监测, 并对任何异常的 SARI 或肺炎病例进行仔细回溯 ; 要求成员国向 WHO 通报或确认所有可能病例或确诊病例 ; 还鼓励各国提高对 MERS 的认识感染的预防和控制措施是至关重要的, 以防止 MERS 冠状病毒在卫生保健设施的可能扩散 MERS 冠状病毒的早期症状的非特异性因此, 卫生保健工作者应该始终一致地应用标准预防措施与所有患者, 无论他们的诊断如何应加给患者的急性呼吸道感染的症状提供医疗服务时的标准预防措施 ; 应增加疾病健康宣教以及个人注意事项在对 MERS-CoV 有更多了解之前, 伴有糖尿病肾功能异常慢性肺病和免疫缺陷疾病的人群被视为 MERS-CoV 的高危人群因此, 这些人在进入农场集市区域时应避免与动物的接触, 尤其是骆驼一般的卫生措施, 如在接触动物前后洗手避免接触患病动物等应被遵守应保持良好的饮食卫生习惯, 应该避免饮用生骆驼奶, 或未彻底煮熟的肉

8 现阶段翰尔希对个人的建议 : 1. 保持良好的个人卫生习惯 ( 具体见预防部分 ), 避免密切接触有呼吸道症状的人, 避免长时间呆着人多的环境中 ; 2. 考虑去中东或出现确诊病例的地区旅行的必要性, 尤其对伴有严重慢性疾病的人 ; 3. 从出现确诊病例地区返回的旅行者, 一旦出现发热咳嗽等急性呼吸道症状, 应避免接触其他人, 并立即就医现阶段翰尔希对公司的建议 : 1. 向员工宣传有关 MRES 的基本信息, 避免照成不必要的恐慌 2. 同健康服务人员一起回顾公司的流感大流行应急预案 3. 基于业务需要考虑公司的旅行限制性建议 4. 鼓励年底季节性流感疫苗注射 5. 对所有重要设施进行流感大流行的桌面推演, 包括测试业务持续性计划 6. 基于公司流感大流行预案检查个人防护用品及其他用品的储备需要了解更多关于流感大流行预案的信息, 请联系翰尔希医疗运营团队 ann_wang@imhealthcare.cn

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