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Understanding MERS

SINGAPORE — Given today’s globalised travel patterns, it is possible for Singapore to have an imported case of Middle East Respiratory Syndrome (MERS), said Dr David Teo, regional medical director of Assistance Services, South and South East Asia at International SOS.

The MERS virus can be transmitted through droplets from the cough or sneeze of an infected person. Photo: Thinkstock

The MERS virus can be transmitted through droplets from the cough or sneeze of an infected person. Photo: Thinkstock

SINGAPORE — Given today’s globalised travel patterns, it is possible for Singapore to have an imported case of Middle East Respiratory Syndrome (MERS), said Dr David Teo, regional medical director of Assistance Services, South and South East Asia at International SOS.

This comes after Thailand confirmed its first MERS case last week. So far, MERS has been reported in 26 countries, including South Korea, China, Malaysia and the Philippines.

First identified in Saudi Arabia two years ago, the MERS coronavirus or MERS-CoV has infected 174 and killed 27 people since the first case was reported in South Korea last month, according to the World Health Organization (WHO) at press time.

Coronaviruses belong to a large family of viruses known to cause respiratory illness and range from the mild common cold to severe acute respiratory syndrome (SARS).

WHO ARE AT RISK?

The young, elderly, and people with underlying medical conditions such as diabetes or kidney disease run a higher risk of contracting MERS and/or succumbing to it due to complicated infections, said Dr Teo.

Other high-risk groups include those who have travelled to affected countries, especially if they have visited hospitals in those places, said Associate Professor Lim Poh Lian, head and senior consultant from the Department of Infectious Diseases at Tan Tock Seng Hopsital (TTSH).

MERS infection has a fatality rate of 35 to 40 per cent, said Assoc Prof Lim. This means about two in five people who contact MERS will die. People in high-risk groups are more likely to become severely ill with lung and kidney failure, she said.

Comparatively, the mortality rate for SARS was about 10 per cent, or one in 10. For seasonal flu and H1N1, the mortality rate is 0.1 per cent, or one in 1,000, said Assoc Prof Lim.

As with other coronaviruses, MERS-CoV can be spread through droplets from the cough or sneeze of an infected person.

However, compared with other coronaviruses, including SARS, MERS is not transmitted as easily from person to person, said Assoc Prof Lim. Hence, she said, the current risk of contracting MERS while in public spaces such as malls, parks and on public transport is low.

MERS is mostly spread in hospitals involving people who have had close contact with someone they did not realise had MERS, added Assoc Prof Lim.

Current evidence suggests that the virus lives in camels and is passed on to humans when they come into close contact with them, or when they consume raw camel meat or camel milk.

SYMPTOMS SIMILAR

TO common cold

Human coronaviruses usually cause respiratory infections. The most common symptoms of MERS infection are fever, cough, chills and shortness of breath, said Dr Teo. Diarrhoea and abdominal pain may also occur.

While most human coronaviruses usually cause only mild respiratory illnesses such as the common cold, MERS-CoV can cause severe respiratory symptoms that will require hospitalisation. However, Assoc Prof Lim noted that in some cases involving younger healthy adults, only mild symptoms were reported.

It is also possible for infected people to not display any known symptoms, said Dr Teo.

It takes about 14 days after exposure to MERS-CoV for a person to become ill. A MERS patient becomes infectious after he starts to experience symptoms of fever and cough, said Assoc Prof Lim. She warned that patients will remain infectious until all the symptoms are resolved.

MASK UP

Surgical masks are likely to provide good protection as the virus is spread through droplets rather than airborne particles, said Assoc Prof Lim.

N95 masks offer more protection than regular masks, she said, but they have to be specially fitted to provide effective protection.

Besides following manufacturers’ instructions when wearing and removing the masks, Dr Teo stresses the importance of also following regular hygiene measures such as thorough hand washing, and disposing the masks properly after use.

At the moment, there are no anti-viral medications available for treating MERS. Assoc Prof Lim said supportive treatment, such as ventilator use, is given to help patients cope until their immune system defeats the virus.

NO NEED TO SHELve

tRAVEL PLANS

There is no official travel restriction by the Singapore Government for travel to areas affected by MERS.

However, Dr Teo advised people who fall ill prior to travelling, and/or have underlying medical conditions such as diabetes or kidney diseases, to consider postponing their trip.

“These people are likely to have lower immunity and, hence, higher risks of getting the virus and/or succumbing to the virus due to complicated infections,” said Dr Teo.

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