(MENAFN- Muscat Daily) Muscat -
Two Omani experts have found a possible cause to the Middle East respiratory syndrome coronavirus (MERS-CoV) cases in the sultanate - a majority of the victims particularly those from North Batinah came in contact with camels.
The study was published in Oman Medical Journal. It was conducted by Dr Salah T al Awaidy from the Ministry of Health and Dr Faryal Khamis from the Department of Infectious Diseases at The Royal Hospital.
It reported, 'In Oman, the first laboratory-confirmed case of MERS-CoV was reported in June 2013. Till March 2018, a total of 11 laboratory-confirmed cases have been reported sporadically. Ten (91 per cent) cases were males with a mean age of 52±17.7 years (range: 20-75 years). Nine cases (82 per cent) were primary and two cases (18 per cent) secondary.'
The study found that patients were predominately from the North Batinah governorate (average rate: 1 per 100,000 population) with a fatality rate of nine per cent. 'Eight cases (73 per cent) reported domestic camel exposure. Uncontrolled diabetes mellitus was the most common comorbidity in eight cases (73 per cent). No secondary cases were reported among the healthcare workers.' Seroprevalence studies revealed MERS-CoV exposure among all the sampled domestic camels across Oman.
'Between January 27 and February 12, 2019, a total of 13 additional human cases of laboratory-confirmed MERS-CoV using real-time polymerase chain reaction (RT-PCR) were reported in Oman.' Eight (61 per cent) and four (39 per cent) patients were residents of North Batinah and South Sharqiyah governorates, respectively.
The first cluster of five females (four from the same family), reported on January 27 and 28, 2019 were from North Batinah. Their mean age was 42±10.8 years (range: 30-59 years). Three of the five females were probably secondary ones exposed to the index case who reported a history of direct contact with camels.
None of the other females had contact with camels. However, four females resided on a farm where camels were kept and the fifth female came into contact with one of the patients suffering from MERS-CoV at the hospital.
Two of the five females died (40 per cent fatality rate). Uncontrolled diabetes mellitus and hypertension were the most common comorbidities reported among three of the cases.
Between February 12 and 18, 2019, North Batinah and South Sharqiyah each reported four additional cases (n=8). These were sporadic cases with no epidemiological link to the previous cluster. Seven patients (88 per cent) were Omani nationals. The mean age of patients were 55±17.5 years (range: 30-77 years) divided equally among males and females. Patients from both the governorates had a history of contact with camels (community).
Two patients from South Sharqiyah were admitted to ICU. 'Uncontrolled diabetes mellitus, hypertension, and ischemic heart diseases were the most common comorbidities present and were reported among three cases including the deceased.'
The case fatality rate was 25 per cent. Through contact screening, two asymptomatic healthcare workers, one from each governorate tested positive for MERS-CoV. Both were involved in the care of MERS-CoV patient (one was involved in intubation). A total of 60 familial contacts from both clusters and 119 healthcare worker contacts were screened for MERS-CoV and monitored for 14 days from the final date of exposure. All tested negative except two.
Between January and March, the season of dromedary camels breeding, races take place in these governorates. It is possible that during these months there is increased MERS-CoV circulation in the animal reservoir. The index cases were in contact with or resided on a farm where camels were kept.
'Individuals in close contact with dromedary camels are at an increased risk of acquiring the infection compared with the general population. The transmission from camels to humans can be via direct contact with camels through respiratory droplets or saliva, or the use of camel products,' the study found.
In the current outbreaks, 'We observed non-linked clusters and sporadic cases, in addition to nosocomial transmission in healthcare facilities with no evidence of sustained human-to-human transmission'. Although most MERS-CoV infected healthcare workers are asymptomatic, 13 serious infections can occur, and healthcare workers might play a critical role in spreading the virus within their area of practice in healthcare facilities.
Several factors could have contributed to the current transmission within healthcare facilities, including delays in suspicion and case detection, and providing close patient care without adherence to infection prevention and control measures.
Hospital transmission of MERS-CoV has been attributed to the suboptimal infection control practices such as lack of personal protective equipment use, poor hand hygiene, delay in timely index case isolation, lack of negative pressure rooms, and performing aerosolising procedures without appropriate personal protective equipment.
MERS-CoV is a zoonotic viral respiratory illness caused by a novel betacoronavirus, which was first reported in Saudi Arabia in 2012. As of January 2019, 2,298 laboratory - confirmed human cases of MERS-CoV from 27 countries have been reported, including 811 associated deaths giving a fatality rate of 35.2 per cent.
Eighty per cent of cases have been reported from countries of the WHO Eastern Mediterranean Region.
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