Overview amp The Role of Public Health Christine Wigen MD MPH Medical Epidemiologist Acute Communicable Disease Control Program Los Angeles County Department of Public Health THANK YOU LAC DPH ID: 679939
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MERS: Middle East Respiratory Syndrome
Overview & The Role of Public Health
Christine Wigen, MD, MPH
Medical Epidemiologist, Acute Communicable Disease Control Program
Los Angeles County Department of Public HealthSlide2
THANK YOU
LAC DPHLaurene Mascola, MD, MPHWendy Manuel, MPHSadina Reynaldo, PhDBrit Oiulfstad, DVM, MPH
D:14\MERS_Tarzana_August 2014
No.
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MERS—Overview & The Role of Public HealthNotes on emerging diseasesMERS basics: transmission, symptoms, treatment, diagnosis, and prevention
Likely sources of MERS infections
Current MERS case count
The role of Public HealthSlide4
New diseases are not uncommon; approx. 12% of new human pathogens are considered “emerging.”
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MERS is an emerging disease.
There are many causes of emerging diseases:
Changes in climate (WNV, dengue, chikungunya)
How we live and travel (allows for more rapid spread of pathogens around the world)
Genetic changes (viruses and bacteria are constantly mutating, becoming resistant to treatment, etc.)
Animals (many pathogens can jump between species; camel exposure likely contributes to MERS)Slide5
What is MERS?
MERS is a coronavirus.Coronaviruses are very commonCells characterized by a crown shape
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To date, all known MERS cases have been linked to countries in and near the Arabian Peninsula
MERS was first reported in Saudi Arabia, September 2012Slide6
Where have MERS cases been
detected?Saudi ArabiaUnited Arab Emirates (UAE)
QatarOmanJordanKuwaitYemenLebanonIran
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Countries with identified cases (n=9):
Countries w/cases from travel (n=11):
United Kingdom
France
Tunisia
Italy
Malaysia
Philippines
Greece
Egypt
USA
Netherlands
AlgeriaSlide7
How is MERS spread?
Close contact with large respiratory dropletsMERS does not spread easily. A study of 280 household contacts of 26 confirmed MERS cases identified only 1 secondary case
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There is no evidence of sustained spread in community settings!Slide8
How are people getting MERS?
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Unknown, but there is mixed evidence of sources:
Close contact with cases
Hospital-acquired cases among health-care workers
But camels can infect people through multiple ways including consumption of undercooked camel meat and raw camel milk. And MERS sequencing also has been found in bats.
Exposure to dromedary (one-hump) camels
A serologic study of dromedary camels in Egypt found 94% positive for MERS-CoV antibodies
3 of 9 recent cases diagnosed in July reported camel exposureSlide9
MERS is not the same as SARS. SARS had sustained community transmission, and some people were “super spreaders.”Slide10
What are the symptoms of MERS?
Fever, cough, shortness of breath (similar to flu)Most known cases have had severe respiratory symptomsPrevalence of those with mild illness is unknown
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What are the diagnostic tests for
MERS?PCR or polymerase chain reactionRespiratory samples are tested to detect acute infectionDone locally by Los Angeles County Public Health (LACDPH)
Serology tests (enzyme-linked immunosorbent assay; confirmatory testing with immunoflorescent assay; definitive confirmatory testing with neutralizing antibody assay) Blood specimens sent to CDC for testing by LACDPHDesigned to look for antibodies to MERS that would indicate a person had been previously infected and developed an immune response
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How is MERS treated?
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No treatment currently available for MERS currently available
Supportive medical care helps ease MERS symptoms
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How is MERS infection
controlled and prevented?Standard, contact, and airborne precautions for symptomatic patients (under evaluation for MERS or confirmed with MERS) requiring hospitalizationHome isolation for those being evaluated or who have been confirmed for MERS not requiring hospitalization
No vaccine available for MERS
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Current MERS Case Count
(as of June 11, 2014)
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699 lab-confirmed cases have been reported to World Health Organization.
209 (30%)
deaths
677 (97%) were males
Median age =
47 oldSlide15
MERS Cases in the United States (US)
Two unlinked, imported cases reported in May 20141First case from IndianaSecond case from FloridaBoth cases traveled from Saudi Arabia to U.S.Both lived in and worked as healthcare workers in Saudi ArabiaBoth had respiratory symptoms and recovered from infection
No close contacts to date with evidence of MERS
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1. CDC. First Confirmed Cases of Middle East Respiratory Syndrome Coronoavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities – May 2014. MMWR Mor Mortal Wkly Rep; 63:431-436.Slide16
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MERS-
CoV
Case
Definition
–
Person
Under Investigation (PUI)Slide17
CDC MERS-CoV Case Definitions –
Confirmed and Probable CasesConfirmed case: person with laboratory confirmation (by RT-PCR on at least two specific genomic targets or a single positive target with sequencing on a second)Probable case: PUI with absent or inconclusive laboratory results for MERS-CoV infection who is a close contact of a laboratory-confirmed MERS-CoV case
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Los Angeles County is one of a handful of cities with very high volume of travel from Saudi Arabia and the United Arab Emirates.
CDC. First Confirmed Cases of Middle East Respiratory Syndrome Coronoavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities – May 2014. MMWR Mor Mortal Wkly Rep; 63:431-436.Slide19
What is Los Angeles County
Department of Public Health (LACDPH) doing?
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What is LACDPH doing?
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A lot!!
Education of key health care partners through continual communications to ensure providers remain alert to possible cases and report any suspect cases to ACDC
immediately
.Slide21
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What is LACDPH doing?
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A lot!!
Education of key health care partners through continual communications to ensure providers remain alert to possible cases and report any suspect cases to ACDC
immediately
.Slide24
What is LACDPH doing?
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A lot!!
Education of key health care partners through continual communications to ensure providers remain alert to possible cases and report any suspect cases to ACDC
immediately
.
Medical consultations for health care professionals (ACDC takes phone calls 24/7)
Public education (website, 211, press releases, FAQs, etc.).Slide25
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What is LACDPH doing?
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A lot!!
Education of key health care partners through continual communications to ensure providers remain alert to possible cases and report any suspect cases to ACDC
immediately
.
Medical consultations for health care professionals (ACDC takes phone calls 24/7)
Public education (website, 211, press releases, FAQs, etc.).Slide27
What is LACDPH doing?
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A lot!!
Medical consultations for health care professionals (ACDC takes phone calls 24/7)
Public education (website, 211, press releases, FAQs, etc.).
Maintain special partnerships with LAX Quarantine and Coroner.
Conduct testing on suspect cases at LAC Public Health Laboratory.
Education of key health care partners through continual communications to ensure providers remain alert to possible cases and report any suspect cases to ACDC
immediately
.
Conduct contact investigations of casesSlide28
What is LACDPH doing?
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This is not new! We have performed these responsibilities for many emerging diseases (e.g., Ebola, enterovirus D68, etc.).
For example, recent travel was part of the SARS rule-out case definition. In 2003, LACDPH conducted testing (and investigation, follow-up, etc.) for 22 possible SARS cases.
More than any other US county!Slide29
What is LACDPH Health doing?
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As of September 19, 2014, LACDPH has conducted MERS rule-out testing on
9
possible cases.
To date, no LAC suspect case has tested positive.
Los Angeles County MERS-CoV rule-out cases 2013-2014
Case#
AdmitDate
Age
Gender
Travel History
Country
Dates*
1
6/25/2013
65
F
Abu Dhabi (UAE)
lives in Dubai
2
8/18/2013
19
M
Dubai (UAE), Sudan, Istanbul
June-8/14
3
10/1/2013
59
F
Israel
7/14-10/01
4
10/8/2013
71
F
Israel
9/15-10/9
5
10/23/2013
66
F
Saudi Arabia
9/22-10/22
6
10/28/2013
70
F
Saudi Arabia
10/7-10/21
7
4/24/2014
84
M
Israel
4/12-4/22
8
6/19/2014
25
M
Dubai (UAE)
lives in Dubai (arrived US 6/8/14)
9
9/11/2014
22
F
Iran
8/21-9/10Slide30
What would happen if a positive
MERS case was identified in LAC?
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LACDPH would report this to the CDC and the California Department of Public Health.
Press releases and alerts would be issued to the public, the medical community, and all other community partners (DRCs, etc.).
DPH would conduct contact investigations and track contacts.
Contacts not requiring hospitalization will be urged to self-isolate and monitor themselves for illness (fever, cough, SOB) for 14 days.
DPH would track contacts for the full length of their self-isolation and conduct testing on contacts if recommended by the CDC and if they become ill during that time period.
In May 2014, as part of the CDC case investigation for the second US travel-associated MERS, LACDPH interviewed and provided specimens for 17 conveyance contacts.Slide31
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MERS—Overview & The Role of Public Health
Emerging diseases are not uncommon.MERS is a viral illness with symptoms similar to the flu.MERS does not spread easily from person-to-person.
Basic infection control can be sufficient for this disease.
The cause of MERS infections is unknown, but camels are suspected.
Public Health plays a central role in the identification and control of MERS cases.
SUMMARYSlide33
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MERS—Overview & The Role of Public Health
Questions???Slide34
Resources
CDC website – Information for health professionals and the public: http://www.cdc.gov/coronavirus/mers/index.htmlWHO website – MERS FAQs: http://www.who.int/csr/disease/coronavirus_infections/faq/en/LAC DPH ACDC Program – Medical consultations for healthcare providers: ph (213) 240-7941, M-F 8am-5pm
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