Press Release

DH closely monitors seven additional overseas MERS cases reported to WHO

27 April 2014

The Department of Health (DH) is today (April 27) closely monitoring seven additional cases of Middle East Respiratory Syndrome (MERS) reported to the World Health Organization (WHO) by the United Arab Emirates (UAE), and hence called on the public to stay alert and maintain good personal, food and environmental hygiene during travel.

According to the WHO, all of them are from Abu Dhabi and are hospitalised under isolation in good condition. Tracing of healthcare and family contacts is ongoing. They include:

• A woman aged 45 with underlying illness who is the daughter of a previously confirmed patient. She became ill on April 15. She has no recent travel history or animal exposure;
• A boy aged four with no underlying illnesses who developed mild illness on April 19. He has no recent travel history or contact with animals. His mother returned to the UAE from the Kingdom of Saudi Arabia (KSA) ten days before his onset;
• A male aged 37 with underlying illnesses who is a contact of a previously confirmed patient. He has no recent travel history but frequently visits two farms which he owns;
• An asymptomatic male aged 32 with no underlying illnesses who is a contact of a previously confirmed patient. He has no recent travel history or animal exposure;
• An asymptomatic male aged 33 with no underlying illnesses who is a contact of a previously confirmed patient. He has no recent travel history. He owns two farms and has contact with camels;
• A male aged 30 with no underlying illnesses who is a contact of a previously confirmed patient. He has no recent travel history or animal exposure; and
• A male aged 42 with no underlying illnesses who is a contact of a previously confirmed patient. He has mild illness. He has no recent travel history or animal exposure.

To date, 261 MERS cases have been reported to the WHO globally, including 93 deaths.

The Centre for Health Protection (CHP) of the DH is seeking more information on the cases from the WHO and relevant health authority. The CHP will remain vigilant and work closely with the WHO and overseas and neighbouring health authorities to monitor the latest developments.

"We have issued letters to doctors and hospitals to draw their attention to the WHO's updated risk assessment," a spokesman for the DH remarked.

The WHO noted that the number of MERS cases had sharply increased since mid-March, particularly in the KSA and the UAE with healthcare-associated outbreaks. About 75 per cent of the recently reported cases appeared to be secondary cases which might have been infected from a confirmed patient. These secondary cases were mainly healthcare workers (HCWs) with no or mild symptoms who had been infected within the healthcare setting.

In addition, recent studies supported that camels served as the primary source. Although there has been slightly more human-to-human transmission than previously observed, the transmission was not sustained.

The WHO indicated that it was very likely that more primary cases would occur, resulting in further transmission. It is also foreseen that cases would continue to be exported to other areas through travellers or pilgrims who might be infected upon exposure to animal, environment or other confirmed patients, such as in a hospital setting.

"We hence urge travellers, apart from avoiding contact with animals, especially camels, or visits to farms, barns or markets with camels, they should not drink raw milk, or consume food which may be contaminated by animal secretions or products, unless they have been properly cooked, washed or peeled," the spokesman reminded.

"As pre-existing major illnesses can increase the likelihood of medical problems, including MERS, during travel, in view of recent pilgrimage activities, pilgrims should consult a healthcare provider before travelling to assess whether it is medically advisable," the spokesman advised.

Locally, the DH's surveillance mechanism with public and private hospitals, practising doctors and at the airport is well in place. Suspected cases identified will be sent to public hospitals for isolation and management until their specimens are tested negative for MERS Coronavirus (MERS-CoV).

"MERS is a statutorily notifiable infectious disease and the CHP's Public Health Laboratory Services Branch is capable of detecting the virus. No human cases have been recorded so far in Hong Kong," the spokesman stressed.

"The Government will be as transparent as possible in the dissemination of information. Whenever there is a suspected case, particularly involving patients with travel history to the Middle East, the CHP will release information to the public as soon as possible," the spokesman remarked.

Early identification of MERS-CoV is important, but not all cases can be detected in a timely manner, especially mild or atypical cases. HCWs should maintain vigilance and adhere to strict infection control measures while handling suspected or confirmed cases to reduce the risk of transmission to other patients, HCWs or visitors. Regular education should be provided.

Travellers returning from the Middle East who develop respiratory symptoms should wear face masks, seek medical attention and reveal their travel history. MERS-CoV should be tested for. Patients' lower respiratory tract specimens should also be diagnosed when possible and repeat testing should be done when clinical and epidemiological clues strongly suggest MERS.

Members of the public are reminded to take heed of personal, food and environmental hygiene:

• Avoid going to farms, barns or markets with camels;
• Avoid contact with animals (especially camels), birds, poultry or sick people during travel;
• Wash hands regularly before and after touching animals in case of visits to farms or barns;
• Seek medical consultation immediately if feeling unwell;
• Avoid visit to healthcare settings with MERS patients;
• Wash hands before touching the eyes, nose and mouth, and after sneezing, coughing or cleaning the nose; and
• Wash hands before eating or handling food, and after using the toilet.

The public may visit the CHP's MERS page (This link will open in a new windowwww.chp.gov.hk/en/view_content/26511.html), the DH's Travel Health Service (This link will open in a new windowwww.travelhealth.gov.hk/english/popup/popup.html) or the WHO's latest news (This link will open in a new windowwww.who.int/csr/don/archive/disease/coronavirus_infections/en/) for more information and health advice.

HCWs may also review the CHP's Letters to Doctors (This link will open in a new windowwww.chp.gov.hk/en/letters/13/31.html) or the WHO's latest risk assessment at its page on coronavirus infections (This link will open in a new windowwww.who.int/csr/disease/coronavirus_infections/en/).