search.noResults

search.searching

note.createNoteMessage

search.noResults

search.searching

orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
orderForm.totalPrice
orderForm.deliveryDetails.billingAddress
orderForm.deliveryDetails.deliveryAddress
orderForm.noItems
THE GOAL OF THIS MIDDLE EAST RESPIRATORY SYN- DROME CORONAVIRUS (MERS-COV) PROGRAM is to provide nurses, lab professionals, nurse practitioners and physi- cians with the information needed for the prompt identifi cation and isolation of suspected MERS-CoV-infected patients to prevent the spread of infection in healthcare facilities. After studying the information presented here, you will be able to:


1 2 3 4


Explain MERS-CoV infections and how they are transmitted to humans


Describe symptoms, complications and diagnosis of the virus


Provide recommendations for preventing the transmission of the virus in hospitals


Discuss how the members of the interprofessional health- care team can stem the spread of MERS in the acute care setting both individually and collectively


Connie Chettle, MS, MPH, RN, and Catherine J. Swift, MT, (ASCP) Are U.S. healthcare professionals ready for another deadly virus? M


iddle East respiratory syndrome is a potentially lethal pulmonary disease caused by a newly emerged coro- navirus. The virus, which is transmitted to humans


from dromedary (one-humped) camels, is not fully understood. It is believed to have originated in bats before it was transmitted to camels. Since human contact with bats is limited, evidence (serological and molecular) suggests that camels are the likely animal reservoir for MERS and the primary zoonotic source for human infection.1-4


MERS-coronavirus (MERS-CoV) was fi rst


identifi ed in Saudi Arabia in 2012. As of February 2016, there have been 1,638 lab confi rmed cases of MERS with 587 deaths.5 All reported cases have had a direct or indirect connection


through travel or residence with nine Middle Eastern countries (Saudi Arabia, United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Yemen, Lebanon and Iran). This includes all cases that have occurred outside of the Arabian Peninsula. Thus far, 26 countries have reported MERS-CoV infections.2,3,6-8 Nurses, nurse practitioners and physicians need to be informed


about this new virus and diligent about including it in the dif- ferential diagnosis of respiratory illnesses. Healthcare providers, especially those who may make initial contact with an infected patient, such as in the ED and outpatient settings, must review thorough travel histories when patients present with acute viral pneumonias. It is of utmost importance that this potential infec- tion be considered in the appropriate circumstances to ensure suspicious fi ndings are identifi ed quickly. Laboratory professionals need to inform the care team regarding safety precautions, speci- men handling, proper specimen collection, and appropriate tests for diagnosis and surveillance. Lab professionals may also serve as a resource or contact between the state health department or Centers for Disease Control and Prevention, and patient caregivers.


What is a coronavirus? Coronaviruses are large, enveloped RNA viruses. Their name is derived from the characteristic crown-like spike glycoproteins surrounding the outer surface of their lipid envelope. Until 2002-2003, coronaviruses were considered relatively unimportant as human pathogens. Little was known about them other than that they continuously circulate


throughout the human population where they cause an estimated 15% to 30% of mild, self-limiting upper respiratory illnesses (colds). However, with the emergence of the fi fth-known human coronavirus named severe acute respiratory syndrome in 2002-2003, the previ- ous lack of concern for coronaviruses abruptly changed. SARS was seen to cause a severe respiratory disease with a high fatality rate. The virus spread easily human-to-human, via droplets, and within a short time, spread from China to four continents. The outbreak lasted approximately six months and resulted in more than 8,000 cases and 774 deaths. During the outbreak, the World Health Or- ganization believed SARS to be a signifi cant threat to global public health; however, the threat of SARS seemed to disappear, and no cases of SARS have been reported since 2004.9 In 2012, approximately 10 years follow-


ing the SARS epidemic, a sixth, more deadly, human coronavirus emerged in the Middle East with the majority of infections occurring in Saudi Arabia, United Arab Emirates, Qatar, Oman, Jordan, Kuwait, and Lebanon. Unlike the SARS virus, which is transmitted easily human-to-human, MERS-CoV transmis- sion is ineffi cient. Scientists initially expected a limited transmission of the virus; however, in May 2015, the situation changed.9,10


South


Korea experienced the largest outbreak of MERS outside the Middle East. The outbreak started with a 68-year-old South Korean businessman who had returned home after visiting four coun- tries in the Middle East. A few days following his return, he became ill and sought medical care at four separate healthcare facilities before he was diagnosed with MERS and isolated. During these visits, the patient transmitted the virus to healthcare workers, patients and visitors. Before the South Korean outbreak was over, secondary, tertiary and possibly quaternary cases of MERS occurred — all epidemiologically linked to this single index patient. Overall, this resulted in 185 cases of MERS with 36 deaths in South Korea.3,8,11


MERS-CoV particles as seen by negative stain electron microscopy. Virions contain charac- teristic club-like projec- tions emanating from the viral membrane. Image courtesy of Cynthia Gold- smith/Maureen Metcalfe/ Azaibi Tami/CDC.


How is MERS-CoV transmitted? Zoonotic Transmission: Although many details of camel-to-human transmission remain unclear, dromedary (one-humped) camels seem to be the major reservoir for MERS-CoV human infections. The strongest evidence for camel-to-human transmission (direct


contact) comes from a study in Saudi Arabia where genomic sequenc- ing showed that the viruses isolated from an infected 43-year-old man and one of his camels were identical.12,13


The infected man


owned nine dromedary camels that he visited daily. During the week before the onset of his illness, four of his camels were sick with a nasal discharge, and the owner treated the nose of one of the ill camels with a topical medicine. The owner became ill seven days later and sought treatment. He died 15 days after hospital admission with MERS-CoV. It should be noted that MERS-CoV has been detected in the nasal and eye discharges, milk and feces of camels.12,13 Indirect Contact: It is uncertain how some MERS-CoV infec-


tions are transmitted from camels to humans. Studies have found MERS-CoV genetic sequences in air samples from a camel barn


2016 • Visit us at NURSE.com 31


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48