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Middle East Respiratory Syndrome Corona Virus (MERS-CoV)

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness that is new to humans. Symptoms can include fever, cough, and shortness of breath. Since it was first reported in Saudi Arabia in 2012, MERS has caused severe illness and even death in people from several countries. The virus has spread globally, including into the United States.

Since MERS first emerged in the Arabian Peninsula in 2012, CDC has been working very actively with global partners to better understand the nature of the virus, including how it affects people and how it spreads. Beginning in Mid-March of 2014, there was a substantial increase in the number of MERS cases reported worldwide. The reason for this increase in cases is not yet completely known. What CDC does know is that because we live in an interconnected world, diseases, like MERS, can make their way to the United States, even when they begin a half a world away.

Understanding the Virus

The virus that causes MERS is called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Coronaviruses are common viruses that most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses. However, MERS-CoV is different from any other coronavirus previously found in people.

We don’t know for certain where the virus came from, but we think it likely came from an animal source. Researchers have found MERS-CoV in camels in from several countries and a bat in Saudi Arabia. We don’t know whether camels are the source of the virus. Studies continue to provide evidence that camel infections may play a role in human infection with MERS-CoV. However, more information is needed.

MERS Symptoms

Some infected people had mild symptoms or no symptoms at all, but most people infected with MERS-CoV developed severe respiratory illness. They had fever, cough and shortness of breath. Others reported having gastrointestinal symptoms, like diarrhoea and nausea/vomiting, and kidney failure. MERS can even be deadly. Many people have died.

How MERS Spreads

MERS-CoV spread into the United States when infected travellers from other countries entered the country. In other countries, the virus has spread from person to person through close contact, such as caring for or living with an infected person. The MERS situation in the U.S. represents a very low risk to the general public in this country.

While experts do not yet know exactly how this virus is spread, CDC advises Americans to help protect themselves from respiratory illnesses by washing hands often, avoiding close contact with people who are sick, avoid touching their eyes, nose and/or mouth with unwashed hands, and disinfecting frequently touched surfaces.

MERS and Travel

CDC does not recommend that anyone change their travel plans because of MERS. The current CDC travel notice is an Alert (Level 2), which provides special precautions for travellers. Because spread of MERS has occurred in healthcare settings, the alert advises travellers going to countries in or near the Arabian Peninsula to provide healthcare services to practice CDC’s recommendations for infection control of confirmed or suspected cases and to monitor their health closely. Travelers who are going to the area for other reasons are advised to follow standard precautions, such as hand washing and avoiding contact with people who are ill.

World Hepatitis Day celebrated at AIMS

28th July is celebrated as a ‘Hepatitis Day’ all across the world in an effort to promote awareness and better understand the disease and its complications. Hepatitis is an inflammatory condition affecting the liver, the most common cause of which is viral infections. Viral hepatitis is not only the leading cause for liver cancers but also the main reason for liver transplants.

There are five viruses primarily responsible for viral hepatitis and they are hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV). Infections caused by these viruses, both in its acute and chronic form, affect millions of people worldwide leading to about 1.4 million deaths per year.

In India, the disease burden of viral hepatitis is substantial and steadily increasing with every year, as is evidenced from the latest data from NCDC (National Centre for Disease Control). Shown below is the viral hepatitis case trend data for year 2010-2013 as reported by IDSP (Integrated Disease Surveillance Program, India)

Ebola Scare – Are we well prepared!!!

As of August 8th 2014, the WHO has declared the recent Ebola virus outbreak as “a public health emergency of international concern”. It almost 10months since the first reported case of the outbreak from Guinea, Africa and the epidemic is gradually spreading all over the globe as more and more cases of Ebola get reported from all over the globe.

Are we there yet?? Officially at least NO!! There have been no confirmed cases of Ebola so far reported from India. There have been a few scares but they were soon dispelled by the Govt. Health officials as false alarms after appropriate diagnosis. According to a recent study in PLOS Currents Outbreaks and the website Ebola Tracking, the risk of India importing this virus from West Africa via air travel is not very high as there are very few to none direct flights connecting India to any of the Ebola stricken nations of West Africa where the epidemic is present in very high proportions. However as a nation we continue be on alert with the Ministry of Health, Govt. of India taking appropriate and timely measures to improve the country’s preparedness to prevent and control the spread of Ebola virus infections in India.

The virus causing the current Ebola epidemic is the similar to the one that was responsible for the first Ebola virus epidemic reported from Zaire, Africa in 1976. The virus belongs to family Filoviridae, order Mononegavirales. Each virion consists of a negative stranded RNA genome that is packaged along with few accessory proteins in a tubular or cylindrical shaped envelope.

The natural reservoir of EBV (Ebola virus) is fruit bats and human infections are primarily a result of ingestions or exposure to infected animals and or their body fluids. The viruses usually gain entry through mucosal surfaces, breaks or abrasions in the skin, or by parenteral introduction. Subsequent human to human transmission leading to outbreaks or epidemics is thought to occur by direct contact with infected patients or cadavers. In an infected patient the viral RNA is detected in semen, genital secretions, skin, nasal secretions and other body fluids. In a medical laboratory setting, infections can happen through exposure to needle stick or EBV-infected blood. Aerosolized transmission mode has not yet been reported in any of the Ebola outbreak or epidemics

In almost 95% of cases the time between exposure and onset of symptoms or disease manifestations is approximately 21 days, which is the recommended period for follow-up of contacts. The average time from the onset of symptoms to hospitalization, a measure of the period of infectiousness in the community was around 5 days while time to death after admission to the hospital was about 4.2 days and about 12 days for discharge.

Ebola virus infections usually manifest as haemorrhagic fevers that begins with flu-like symptoms (fever, chills, malaise, and myalgia) that later escalates to a critical multisystem involvement. Some of the commonly observed signs and systems include systemic (prostration), gastrointestinal (anorexia, nausea, vomiting, abdominal pain, diarrhoea), respiratory (chest pain, shortness of breath, cough), vascular (conjunctival injection, postural hypotension, edema), and neurologic (headache, confusion, coma) manifestations. Other frequently observed manifestations include petechiae, ecchymoses, and mucosal bleeding and post-mortem evidence of visceral haemorrhagic effusions. A macropapular rash with erythema that shows up by day 5 or 7 of the illness is a very useful differential diagnosis characteristic.

Dengue & Chikungunya are both a public health and economic burden.

The findings from a recent study conducted by the researchers at Brandeis University’s Schneider Institutes for Health Policy, the INCLEN Trust International in New Delhi and the ICMR’s Center for Research in Medical Entomology (CRME) in Madurai, Tamil Nadu has revealed the extent of underreporting of the official dengue cases in India. According to the study results, the actual annual number of dengue cases is about 282 times higher than officially reported. This may not come as a huge surprise for many of the health care professionals in this country who have been encountering a steady increase in dengue cases in their practice for a few years now. The public health data on dengue incidence and prevalence are often misleading and it’s time we face up to the fact that many parts of India especially the southern regions are hyper endemic to dengue. Even though dengue has been categorized as a public health priority at both national and state levels and aggressive preventive and vector control measures employed, scourge of dengue continues.

The other equally important finding by Shepard et al was the economic cost of dengue on the nation’s economy. The direct health care cost associated with dengue was calculated to be about $6.77/day per capita (i.e. Rs 400-500/day) and after factoring the other indirect expenses incurred the overall annual economic costs of dengue illness in India amounts to be about $1.11 billion or a whooping 111 crores!!!

Dengue is not the only arboviral disease capable of inflicting such a huge health and economic burden on the nation. Outbreaks of Chikungunya viral infections, another mosquito borne alphavirus infection, can have equally debilitating health and economic impact. So far there have been no comprehensive studies, similar to that done for dengue, to better understand the economic and disease burden of Chikungunya infection outbreak. However, results from a few localized studies have provided us with snapshot of the potential disease burden. A 2010 study done by Murtola T et al estimated the immediate cost of Chikungunya and dengue infections to household in the Indian state of Gujarat at US$ 1.48 billion (range US$ 0.64 billion to US$ 3.60 billion). A household survey study done in Gujarat in 2006 found that only 23% of Chikungunya cases sought care in public facilities clearly highlighting the extent of under-reporting in Chikungunya cases. A further cost analysis of CHIKV outbreak situations revealed the total economic cost at US$ 8.6-US$ 17.3 million.

Increasing human travel, climatic changes and re-introduction and expansion of vectors to new geographical locations can have a profound impact on the scale and scope of mosquito borne viral infections like dengue and Chikungunya. The need to study the economic impact of such illnesses should also be a ‘high’ public health priority. This in turn will help us implement appropriate and timely cost–effective preventive and control strategies which may include novel vector management and/or introduction of vaccines or prophylactics to select high risk population or to the general public.